AGD House of Delegates (HOD)
Policy Manual
Advocacy Polices & Guidelines
HOD 2012
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TABLE OF CONTENTS ....................................... ERROR! BOOKMARK NOT DEFINED.
CURRENT POLICIES .......................................... ERROR! BOOKMARK NOT DEFINED.
PUBLIC AFFAIRS POLICIES ............................. ERROR! BOOKMARK NOT DEFINED.
ADVOCACY POLICIES........................................................................................................................... 7
Accreditation and Recognition of Non-Specialty Areas ....................................................................... 7
Advertising of Credentials ...................................................................................................................... 8
Advertising of Credentials .......................................................................................................................... 8
Advocacy Fund ........................................................................................................................................ 8
American Dental Association ................................................................................................................. 8
Advertising campaign, no AGD position on ............................................................................................... 8
Requirement by AGD for membership in ................................................................................................... 8
Anesthesiology ......................................................................................................................................... 9
Cost of providing benefit............................................................................................................................. 9
Training availability .................................................................................................................................... 9
Annual Meeting ....................................................................................................................................... 9
ADEA, report to House by Legislative and Governmental Affairs Council................................................ 9
Contracts .................................................................................................................................................. 9
Contract analysis service ............................................................................................................................. 9
Dental Auxiliaries .................................................................................................................................. 10
Advanced Dental hygiene Practitioner Position Statement ....................................................................... 10
Dental team concept .................................................................................................................................. 10
Perform under direct supervision of general dentist .................................................................................. 10
Training, education, and utilization of ...................................................................................................... 10
Dental Consultant .................................................................................................................................. 11
Coalition to restore deduction for student loan interest ............................................................................. 11
Must be a licensed dentist ......................................................................................................................... 11
Dental Education ................................................................................................................................... 11
Deduction of interest paid on student loans............................................................................................... 11
Dental schools, support state funding for .................................................................................................. 11
Formal academic process leading to a degree or certificate ...................................................................... 11
Four-year curriculum, support of .............................................................................................................. 11
Liaison consortium .................................................................................................................................... 12
Licensure ................................................................................................................................................... 12
Dental Laboratory Techniques ............................................................................................................ 12
Dental Materials .................................................................................................................................... 13
Purchasing decisions ................................................................................................................................. 13
Dental Practice....................................................................................................................................... 14
Amalgam, position statement supporting .................................................................................................. 14
Uses for, procedures must be publicly disclosed ......................................................................................... 14
ANSI MD 156, AGD representative on .................................................................................................... 14
Appropriate charges made for administrative work .................................................................................. 15
Benefit coverage for dental surgery performed in office ........................................................................... 15
Biophosphonate therapy ............................................................................................................................ 15
Bleaching trays, license should be required for fabrication of .................................................................. 15
Botox ......................................................................................................................................................... 16
Child’s first visit to dentist, position on .................................................................................................... 16
Claims, prompt payment of ....................................................................................................................... 16
Code of procedures, endorsed by AGD ..................................................................................................... 16
Consultant, ground rules for claims denial ................................................................................................ 16
Co-payment and overbilling, waiver of ..................................................................................................... 17
Corporate Guidelines and Mandates ......................................................................................................... 17
Date of manufacture of dental equipment and devices .............................................................................. 17
Dental health education for the public....................................................................................................... 17
Dental hygienists, authority of State Boards of Dental Examiners ............................................................ 18
Dental Implants ......................................................................................................................................... 18
Dental insurance plan to include all facets of dentistry ............................................................................. 18
Dental products, materials, and medications, opposed to bans on the use of ............................................ 18
Dental research, public funding for ........................................................................................................... 18
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Dentistry's position on a National Health Program ................................................................................... 18
Dentist's right to collect a larger fee from patient ...................................................................................... 18
Diagnosis and supervision needed for dental treatment ............................................................................ 19
Diagnostic tests, dentists’ right to prescribe and perform.......................................................................... 19
Environmental “best management” practices ............................................................................................ 19
Expanded Function Dental Assistant (EFDA) ........................................................................................... 19
Evidence-based dentistry........................................................................................................................... 19
Definition of ................................................................................................................................................ 20
Use of .......................................................................................................................................................... 20
Fees, adjustment of.................................................................................................................................... 20
Fees; i.e., usual, reasonable, customary: definition of ............................................................................... 20
First Dental Visit Timing and Establishment of the Dental Home (AAP Policy Proposal) ....................... 20
Flexible Spending...................................................................................................................................... 21
Fluoridated public water supplies, public funding for ............................................................................... 21
Fluoride in water supplies and toothpaste, position statement................................................................... 21
Freedom of choice provider ...................................................................................................................... 21
Health care reform..................................................................................................................................... 21
Health care reform criteria ........................................................................................................................ 21
Licensing ................................................................................................................................................... 23
Criteria for eligibility................................................................................................................................... 23
Uniform standards for ................................................................................................................................. 23
Voluntary/Temporary Licensing ................................................................................................................. 23
Medically compromised dental patients .................................................................................................... 23
Disclosure of relevant information .............................................................................................................. 23
Policy statement on treatment of ................................................................................................................. 24
Medically indigent, support programs for ................................................................................................. 25
Medicare, amendment to reimburse dentists for rendering same service as a physician ........................... 25
Nutrition and oral health ........................................................................................................................... 25
Oral Conscious Sedation, position statement ............................................................................................ 26
Parameters of care, ADA .......................................................................................................................... 26
Parameters of care, criteria for .................................................................................................................. 27
Preferred Provider Organizations .............................................................................................................. 27
Prepayment plans ...................................................................................................................................... 28
Bill payer system ......................................................................................................................................... 28
Exclude certain contract language ............................................................................................................... 28
Include all phases of preventive dental services .......................................................................................... 29
Structuring of dental prepayment programs................................................................................................. 29
Public information available to public of dental office safety ................................................................... 29
Resource-Based Relative Value Scale ....................................................................................................... 30
Rights of employers to provide health care benefits .................................................................................. 30
School curricula – oral health education ................................................................................................... 30
Soft drink consumption/pouring rights contracts....................................................................................... 30
Supervision, definitions of for dental hygienists and other dental auxiliaries ........................................... 30
Surgeon General's Report on Oral Health ................................................................................................. 31
Implementation plan .................................................................................................................................... 31
Third party mechanisms ............................................................................................................................ 32
ADA's role in problems with ....................................................................................................................... 32
Claim contested by dental consultant of ...................................................................................................... 32
Considerations in deliberating dental health insurance programs ................................................................ 32
Consultant of, should make no representation to patient regarding dentist's service or fee .......................... 33
Diagnostic imaging ..................................................................................................................................... 33
Differentials in levels of reimbursement in.................................................................................................. 33
Fee Determination ....................................................................................................................................... 33
Fee schedules based on utilization reviews considered arbitrary ................................................................. 33
Guidelines for handling members’ problems with ....................................................................................... 33
Not to interfere with dentist's diagnosis and treatment ................................................................................ 34
Overpayment recovery practices ................................................................................................................. 34
Participation should not be contingent upon participation in government regulated programs .................... 34
Reduction/denial of dental benefits must be signed by licensed dentist ....................................................... 35
Regulated by law or state governmental agency .......................................................................................... 35
Tissue biopsy............................................................................................................................................. 35
TMD policy statement ............................................................................................................................... 35
TMJ ........................................................................................................................................................... 36
Tooth numbering system ........................................................................................................................... 36
Untoward responses to products, materials, and medications ................................................................... 36
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Workforce, adequacy of present dental workforce .................................................................................... 36
Work force issues, position statement ....................................................................................................... 37
Dental Practices ..................................................................................................................................... 37
Open elections and nominations for officers ............................................................................................. 37
To be owned and operated by licensed dentists ......................................................................................... 37
Dental Students ...................................................................................................................................... 38
Financial assistance to, that restricts choice of geographical location of practice ..................................... 38
Loan program for ...................................................................................................................................... 38
Recruiting highly qualified students .......................................................................................................... 38
Denturism............................................................................................................................................... 38
Direct Reimbursement .......................................................................................................................... 38
Definition of .............................................................................................................................................. 39
Promotion of ............................................................................................................................................. 39
Dues ........................................................................................................................................................ 39
Assessment ................................................................................................................................................ 39
Enteral Conscious Sedation .................................................................................................................. 39
Federal Services ..................................................................................................................................... 39
Benefits for military personnel and their dependents ................................................................................ 40
Salary reimbursement for military dentists ............................................................................................... 40
Special pay for uniformed services ........................................................................................................... 40
Fees ......................................................................................................................................................... 41
Adjusted for complying with governmental regulations ........................................................................... 41
General Dentist ...................................................................................................................................... 41
Continued competency .............................................................................................................................. 41
Creed of..................................................................................................................................................... 41
Coordinate and manage dental health ........................................................................................................ 42
Definition of .............................................................................................................................................. 42
Primary dental care provider, defined ....................................................................................................... 42
Primary entry point into dental care system .............................................................................................. 42
General Practice Residency Program .................................................................................................. 43
Commission on accreditation urged to require that directors of GPR's be general dentists ....................... 43
Geriatric Care ........................................................................................................................................ 43
Health Planning ..................................................................................................................................... 43
Organized dentistry to provide input for ................................................................................................... 43
HIV ......................................................................................................................................................... 44
HIV-infected patients, policy on ............................................................................................................... 44
Statement on disclosure and infection control ........................................................................................... 44
Implants ................................................................................................................................................. 44
Pre-doctoral education............................................................................................................................... 45
Infectious Waste .................................................................................................................................... 45
State and government regulation ............................................................................................................... 45
Insurance, Malpractice ............................................................................................................................ 45
Legislation .............................................................................................................................................. 45
Access to dental care ................................................................................................................................. 45
Incentives for dentists to practice in underserved areas ............................................................................... 45
Legislative agenda for providing ................................................................................................................. 46
AGD opposes limiting political or PAC contributions .............................................................................. 48
Cash method of accounting, not accrual .................................................................................................... 48
Community Health Centers ....................................................................................................................... 48
Deduction for member dues ...................................................................................................................... 48
Dental Lab Disclosure ............................................................................................................................... 48
Federal Trade Commission ....................................................................................................................... 49
FTC's efforts to pre-empt state laws re corporate ownership .................................................................... 49
General Practitioner's role as gatekeeper for oral health ........................................................................... 49
Government subsidized health care programs ........................................................................................... 49
Guidelines for dealing with state legislation ............................................................................................. 49
Indigent population, AGD as a voice for the ............................................................................................. 50
Language interpretation at provider’s expense .......................................................................................... 50
Legislative or regulatory mandates with inadequate scientific basis ......................................................... 50
Link between periodontal disease and low birth-weight babies ................................................................ 50
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Mandating preferred provider organizations ............................................................................................. 52
Military dentists, special pay and incentives for........................................................................................ 52
National Practitioner Data Bank................................................................................................................ 52
NIDCR ...................................................................................................................................................... 52
Nitrous oxide inhalation sedation .............................................................................................................. 52
Prohibiting latex use without documented scientific evidence .................................................................. 52
Protect dental insurance as a fringe benefit ............................................................................................... 53
Public disclosure of information in National Practitioner Data Bank ........................................................ 53
Public Health Service Surgeon General .................................................................................................... 53
Sales tax on professional services - AGD opposition ................................................................................ 53
State over federal regulation of the dental profession ............................................................................... 54
Student Loan Interest Deduction ............................................................................................................... 54
Tax credit in states with reimbursement rates below 75th percentile ......................................................... 54
Tobacco Cessation Treatment ................................................................................................................... 54
Tobacco settlement earmarked for health care .......................................................................................... 54
Water quality during routine dental treatments should be appropriate ...................................................... 54
Licensing ................................................................................................................................................ 54
Limited to dentists and dental hygienists .................................................................................................. 54
Licensure ................................................................................................................................................ 55
By credentials ............................................................................................................................................ 55
Malpractice Insurance and Litigation ................................................................................................. 55
Defending their capabilities to render dental procedures .......................................................................... 55
Mandated Health Benefits .................................................................................................................... 56
AGD policy on .......................................................................................................................................... 56
National Practitioner Data Bank ......................................................................................................... 56
OSHA ..................................................................................................................................................... 56
AGD efforts to control regulations relating to infectious waste control .................................................... 56
AGD influence in adopting guidelines ...................................................................................................... 56
AGD supports the ADA’s position on OSHA’s anticipated rule on Workplace Safety & Health ............. 57
Worker safety regulation, opposition ........................................................................................................ 57
Patient Records ...................................................................................................................................... 57
Confidentiality of ...................................................................................................................................... 57
Pediatric Dentistry ................................................................................................................................ 57
Defined ...................................................................................................................................................... 57
Peer Review Committees ...................................................................................................................... 57
For general dentists ................................................................................................................................... 57
Quality control review by .......................................................................................................................... 58
Post Graduate Training ........................................................................................................................ 58
Availability for all recent graduates .......................................................................................................... 58
Public Information ................................................................................................................................ 59
Monitoring dental health messages to the public ...................................................................................... 59
Radiographs ........................................................................................................................................... 59
Dental assistants must be properly trained to use ...................................................................................... 59
Submission to insurance carriers ............................................................................................................... 59
Salaried Dentists .................................................................................................................................... 59
Sedation .................................................................................................................................................. 59
Adequate facilities for teaching ................................................................................................................. 59
Teaching of, at the undergraduate and CE levels ...................................................................................... 59
Smoking .................................................................................................................................................. 60
AGD position on use of Tobacco .............................................................................................................. 60
Specialty License Laws ......................................................................................................................... 60
Specialty Listings ................................................................................................................................... 60
State Board of Dentistry ....................................................................................................................... 60
Sterilization ............................................................................................................................................ 61
Procedures ................................................................................................................................................. 61
Surveys ................................................................................................................................................... 62
Of dental schools, annually ....................................................................................................................... 62
Table of Allowances .............................................................................................................................. 62
Acceptable reimbursement mechanism ..................................................................................................... 62
PUBLIC AFFAIRS GUIDELINES ............................................................................................................ 63
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Advocacy Guidelines .............................................................................................................................. 64
Announcement of Credentials to The Public: A Position Paper.......................................................... 64
Coordination of Benefits Guidelines ......................................................................................................... 66
Dental Care Policy Guidelines .................................................................................................................. 68
Educational Objectives for the Provision of Dental Implant Therapy by Dentists .................................... 70
Enteral Conscious Sedation White Paper.............................................................................................. 77
Handling Legislation Regarding General Anesthesia and Sedation Guidelines ........................................ 86
National Health Care Reform Position Paper ............................................................................................ 90
Position Statement on the Advanced Dental Hygiene Practitioner (ADHP) Concept ....................... 96
Referring Dental Patients to Specialists and Other Settings for Care General Guidelines ...................... 104
Universal Access to Health Care Position Paper ..................................................................................... 109
White Paper on Increasing Access to and Utilization of Oral Health Care Services ....................... 117
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Advocacy Policies
Accreditation and Recognition of Non-Specialty Areas
2005:5-H-7
“Resolved, that the AGD adopt the following position regarding the
accreditation and recognition of non-specialty areas of general dentistry:
AGD Position on
the Accreditation and Recognition of Non-Specialty Areas
The AGD supports excellence in general dentistry and the pursuit of
professional development through lifelong learning. Advanced education
should meet independent standards so that the education is valid and
provides the framework for excellent patient care. General dentistry is not
just treating patients – it is being the educated gatekeeper of oral health so
that the patient is provided with all the available options for treatment. The
knowledge of when to treat and when to refer, and to whom, is the
responsibility of the general dentist. The general dentist’s emphasis is on
primary care. They guide patients to efficient, cost effective treatment
while maintaining continuity of care.
AGD supports the responsibility of the Commission on Dental
Accreditation (CDA) to develop accreditation standards for all formal
education programs in dentistry, whether they are in an ADA-recognized
specialty, in general dentistry or in a non-specialty area of general dentistry.
This is not changing the scope of practice for general dentists and dental
specialists, nor is it adding new specialties. If non-specialty areas that
provide formal advanced education can seek accreditation then the public
will benefit.
The general dentist is the coordinator of care and as such should be able to
inform the patient of all available treatment options. The general dentist
should have access to education in all areas of dentistry, including advanced
education programs and continuing dental education.
The specialist is a partner in dental treatment that is dependent upon patient
referral from a general dentist. If general dentists have had additional
education and training they are able to provide better patient care, treatment
planning and know better when to refer to a specialist or another general
dentist. This will strengthen the profession.
It is not as important an issue that the public understand the scope of
practice between practitioners as it is that they understand how oral health
affects their overall health. Clear messages about why it is important to see
the general dentist twice a year would be powerful messages to the majority
of the public who are interested in their health. Whether the public sees a
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specialist or a general dentist should be on the recommendation of their
general dentist
The ADA is uniquely poised to promote the image of modern dentistry to
the public. It is not the role of the ADA to make patients aware of how to
select a specialist – that is the role of the referring general dentist. The
ADA should focus on getting the public to the dentist and in working within
the legislative arena to see that access to care is improved.
As CDA accredits advanced education programs in general dentistry, the
ADA should consider mechanisms for recognizing board certification in
general dentistry areas, including the American Board of General
Dentistry.”
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Advertising of Credentials
Advertising of Credentials
2008:314R-H-7
“Resolved, that the AGD adopt Announcement of Credentials to the Public: A
Position Paper as its policy on the announcement of its FAGD and MAGD
credentials.”
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Advocacy Fund
2009:315R-H-7
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American Dental Association
Advertising campaign, no AGD position on
98:19-H-7
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“Resolved, that the AGD create an Advocacy Fund.”
“Resolved, that the AGD take no formal position on the ADA’s institutional
advertising campaign and accompanying assessment.”
Requirement by AGD for membership in
79:15-H-6
REVISED
HOD 7/99
“Resolved, that it shall continue to be AGD policy to encourage membership in
the American Dental Association, the Canadian Dental Association, or the
National Dental Association.”
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Anesthesiology
Cost of providing benefit
2002:29-H-7
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“Resolved, that the Academy of General Dentistry believes patients with physical,
developmental, emotional, or medically compromising conditions may require
sedation/general anesthesia in private office, hospital, or surgical center settings
for the safe and effective treatment of dental disease and/or injury, and be it
further
Resolved, that sedation and/or general anesthesia and related facility costs for
the treatment of dental disease and/or injury in these patients should be a
covered benefit in all group medical benefit policies and Medicaid.”
Training availability
90:54-H-7
"Resolved, that the Academy of General Dentistry work with the American Dental
Association and the American Dental Education Association to recommend that
dental schools and hospital-affiliated teaching institutions establish
anesthesiology programs so that dentists seeking in-depth education in
anesthesiology will have such training available."
94:14.2-H-7
"Resolved, that educational opportunities be available so that general dentists
will have adequate opportunity for training in dental anesthesiology in order to
provide optimum pain and anxiety control for the public."
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Annual Meeting
ADEA, report to House by Legislative and Governmental Affairs Council
94:22.2-H-7
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"Resolved, that the Legislative and Governmental Affairs Council annually
report to the Academy of General Dentistry's House of Delegates on the
activities of dental schools and other organizations as they relate to the political
concerns of general dentistry."
Contracts
Contract analysis service
2008:110-H-7
“Resolved, that Policy 88:47-H-7 be amended so that it reads:
“Resolved, that the Academy of General Dentistry offer to its members a
contract analysis service, and be it further
Resolved, that members be encouraged to seek the advice of their own
attorney before deciding to sign a contract, and be it further
Resolved, that the Dental Practice Council develop means to educate
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Academy of General Dentistry members about the ramifications of
provider contracts.”
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Dental Auxiliaries
Advanced Dental hygiene Practitioner Position Statement
“Resolved, that the AGD adopt the Position Statement on the Advanced
Dental Hygiene Practitioner (ADHP) Concept.”
2008:322-H-7 (REAFFIRMED
2010:307-H-7)
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Dental team concept
86:30-H-7
(RE-AFFIRMED
2010:307-H-7)
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Resolved, that this policy be conveyed to the American Dental Association, the
American Dental Hygienists Association, and state and provincial boards of
dental examiners."
Perform under direct supervision of general dentist
73:24-H-10
(RE-AFFIRMED
2010:307-H-7)
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"Resolved, that the Academy of General Dentistry supports the dental team
concept as the best approach to providing the public with quality
comprehensive dental care, and firmly supports direct supervision of the
practice of dental hygiene, and be it further
"Resolved, that all duties performed by any dental auxiliary must be done under
the direction and control of the dentist and that he or she be directly
responsible for the actions of his or her auxiliaries performing those duties."
Training, education, and utilization of
2010:305-H-7
“Resolved, that HOD policy 74:13-H-11 be amended”
"Resolved, that in the training, education and utilization of dental auxiliaries for
the purpose of assisting the dentist in providing high quality dental care through
performance of expanded functions, it shall be the recommendation of the
Academy of General Dentistry that such auxiliaries be permitted to perform
under the direct supervision of the dentist those functions which do not require
the professional skill and judgment of the dentist and are in compliance with laws
of states which have provisions for expanded functions, and be it further
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Resolved, that the dentists, and only the dentist, is responsible for the
examination, making the diagnosis and formulating the plan of treatment,
performing surgical or cutting procedures on hard or soft tissue, fitting and
adjusting corrective and prosthodontic appliances, prescribing therapeutic
agents and making impressions for other than study casts, and be it further
Resolved, that final decisions related to dental practice and utilization of dental
auxiliaries rest and the state board of dentistry, and be it further
Resolved, that the AGD recognize the necessity of effectively utilizing dental
auxiliaries to maximize the efficient use of the dentist's time and skills."
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Dental Consultant
Coalition to restore deduction for student loan interest
93:29-H-7
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Must be a licensed dentist
75:27-H-10
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"Resolved, that the AGD recognizes that a dental consultant must be a duly
licensed dentist within said state."
Dental Education
Deduction of interest paid on student loans
2008:301S-H-7
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"Resolved, that the Academy of General Dentistry support the efforts of the
Student Loan Interest Deduction Restoration Coalition to restore the deduction of
interest paid on student loans."
“Resolved, that the Academy of General Dentistry support efforts to restore the
full deduction of interest paid on student loans regardless of income.”
Dental schools, support state funding for
80:22-H-7
"Resolved, that AGD recognizes the need for adequate funding to enable dental
schools to provide a proper dental education, but at the same time, AGD
encourages dental schools to seek state and/or private support in lieu of federal
capitation funding."
81:37-H-7
"Resolved, that AGD support the concept of using state funds to assist in
maintaining and operating the physical facilities of existing dental schools."
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Formal academic process leading to a degree or certificate
81:41-H-7
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Four-year curriculum, support of
78:27-H-6
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"Resolved, that AGD endorse the concept of a formal academic process of
structured, sequential continued or post-doctoral education, earned through
universities or academically accredited teaching institutions over an extended
amount of time, which lead to a degree or a certificate."
"Resolved, that the AGD expresses its concern with the dilution and shortening of
dental school programs for purpose such as the receiving of federal capitation
grants, and be it further
Resolved, that the AGD supports a minimum of a four-year approved
curriculum to achieve a dental degree, and be it further
Resolved, that the AGD send a letter to all of the existing dental schools
expressing our support of those dental schools which have relinquished their
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three-year programs in favor of pursuing quality four-year dental education
programs."
Liaison consortium
98:31-H-7
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“Resolved, that the Academy of General Dentistry convene a ‘Liaison Consortium’
to consist of two representatives from the Academy of General Dentistry (AGD),
two representatives from the American Dental Education Association (ADEA), two
representatives from the American Association of Hospital Dentists (AAHD), one
representative each from the Federal Services Board, the American Board of
General Dentistry, and the Veteran’s Administration Residency Programs to meet
twice each year beginning in April of 1999, and be it further
Resolved, that the mission of the consortium will be to coordinate the
representation of predoctoral and postdoctoral general dentistry educators by
identifying their needs, facilitating communication, and promoting resource
sharing among the involved organizations.”
Licensure
82:34-H-7
"Resolved, that in states where laws are already in effect which mandate
involvement in continuing education as a condition of dental licensure and/or
dental license renewal, AGD's constituent AGD in that state's jurisdiction work
with the state board of dental examiners and other appropriate dental agencies
to protect the interests of AGD members in that state as mechanisms for
enforcement and administration of that requirement are developed and
implemented.
96:46-H-7
"Resolved, that the Academy of General Dentistry encourage its constituent
academies to work with state or provincial boards of dental examiners, state
legislatures, or regulatory bodies in implementing the following provisions for
mandatory continuing dental education when legislation or regulations are under
consideration in their states or provinces:
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acceptance of program providers approved by the AGD of General
Dentistry, ADA Continuing Dental Education Recognition Program and
the AGD's intrastate approval program;
2.
the acceptability of self-instruction programming;
3.
acceptance of the AGD member printout as one form of
documentation of the requirement;
4.
acceptance of courses relative to the access and delivery of dental
care."
Dental Laboratory Techniques
76:40-H-11
"Resolved, that the Academy of General Dentistry urge the American Dental
Association to, in turn, influence the schools of dentistry to provide significant
instruction in dental laboratory technology for dental students so that dental
school graduates will have the ability to adequately supervise the laboratory
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technicians, and be it further
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Resolved, that the Academy of General Dentistry urge the American Dental
Association to, in turn, influence the schools of dentistry to institute programs
of instruction to train dental laboratory technicians at the college and
vocational school level”
Dental Materials
79:30-H-6
"Resolved, that the AGD recognizes the need to give the American Dental
Association's Council on Dental Materials and Devices appropriate input from
general dentists, and be it further
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Resolved, that the AGD recognizes the opportunity given to its president in the
Bylaws to appoint an appropriate representative when it is appropriate for him
to do so, and be it further
Resolved, that the AGD's representative to the American National Standards
Committee MD156 for Dental Materials and Devices be named as a consultant
to the AGD's Dental Practice Council, if he is not already a member, and be it
further
Resolved, that all problems concerning dental materials and devices be
considered under the purview of the AGD Dental Practice Council."
79:31-H-6
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Purchasing decisions
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"Resolved, that attendance at MD 156 Committee meetings by a representative
of the Academy of General Dentistry be included in the Dental Practice Council’s
budget, on an annual basis."
"Resolved, that the Academy of General Dentistry recognizes the problem of
providing the general practitioner with meaningful information upon which to
base purchasing decisions, and be it further
Resolved, that the following strategies be implemented in order to accomplish
this purpose:
1.
Maintain an AGD representative on ANSI MD 156.
2.
Recommend through the Dental Practice Council chairman members to
participate on ANSI Subcommittees.
3.
Relay to the ADA AGD's concerns with regard to having the practicing
dentist more informed in order to make proper purchasing decisions.
4.
Identify which products should be evaluated.
5.
Relay ANSI information to the AGD Foundation Product Comparison
Advisory Board.
6.
Start Product Comparison Program through AGD Foundation.
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10
11
12
13
8.
Obtain feedback from our membership on which products should be
evaluated.
9.
Appoint subcommittee of Dental Practice Council to facilitate dental
material and device deliberations for the Council."
Amalgam, position statement supporting
“Resolved, that based on current scientific evidence, including the Food and Drug
Administration’s February 2002 Consumer Update on Dental Amalgam, the
Academy of General Dentistry maintains that amalgam is safe and effective as a
dental restorative material.”
Analyzed health care data
Methodology and source of funding must be disclosed if used for Benefit
determination
2000:24-H-7
20
21
22
“Resolved, that if information gathered from analyzed healthcare data is used for
either benefit determination or dentist preferential selection, then the
methodology and source of funding involved in the analysis must be publicly
disclosed and verified by a process that ensures the quality, integrity, and validity
of the analysis methodology.”
Uses for, procedures must be publicly disclosed
2000:23-H-7
23
24
25
26
27
28
29
Publish results of product comparison program in our Journal.
Dental Practice
2002:24-H-7
14
15
16
17
18
19
7.
“Resolved, that the Academy of General Dentistry supports the concept that if
health care data is analyzed, it should only be used to advance scientific
knowledge or improve the oral health of the patient, while still allowing for
professional judgments by practitioners, and be it further
Resolved, that the procedures involved in the analysis must be publicly
disclosed and reviewed by the affected communities of interest in order to
ensure the quality, integrity, and validity of the analysis methodology.”
ANSI MD 156, AGD representative on
97:25-H-8
“Resolved, that the Academy of General Dentistry recognizes the problem of
providing the general practitioner with meaningful information upon which to
base purchasing decisions, and be it further
30
14
1
2
3
4
5
6
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8
9
10
11
12
13
14
15
16
Resolved, that the following strategies be implemented in order to accomplish
this purpose:
3.
Relay to the ADA AGD's concerns with regard to having the practicing
dentist more informed in order to make proper purchasing decisions.
4.
Obtain feedback from our members on materials with which they’ve
experienced problems.”
"Resolved, that the AGD recognize that it is ethical and proper for appropriate
charges to be made when a dentist completes a claim form, a narrative report or
other paperwork requiring secretarial, clerical, and professional time as long as
the fee is identified."
"Resolved, that AGD support the inclusion of clauses in hospitalization and
surgical benefits contracts that provide for coverage for dental surgery in the
office setting if such surgery would normally be covered were the patient
hospitalized for the procedure."
“Resolved, that the AGD communicate the potential serious oral sequelae of
bisphosphonate therapy, including osteonecrosis, to the medical and dental
communities, and to inform patients of such risk and encourage patients to seek
dental care prior to initiating bisphosphonate therapy."
Bleaching trays, license should be required for fabrication of
2001:27-H-8
26
27
28
29
30
31
Recommend members to participate on ANSI subcommittees through the
Dental Practice Council Chairperson.
Biophosphonate therapy
2007:27R-H-8
23
24
25
2.
Benefit coverage for dental surgery performed in office
79:35-H-6
20
21
22
Maintain an AGD representative on ANSI MD 156.
Appropriate charges made for administrative work
75:28-H-10
17
18
19
1.
“Resolved, that the Academy of General Dentistry believes that supervising or
providing materials or methodology for consumers to make intraoral impressions
constitutes the practice of dentistry, which requires an appropriate license in the
state or province where the individual is being treated, and be it further
Resolved, that directing a dental laboratory to fabricate intraoral appliances
and devices (including bleaching trays) constitutes the practice of dentistry,
which requires an appropriate license in the state or province where the
individual is being treated, and be it further
15
1
2
3
4
5
6
7
8
Resolved, that in order to protect the health of the public, the Academy of
General Dentistry believes that the fabrication of intraoral appliances and
devices (including bleaching trays) by dental laboratories requires a proper
prescription by a dentist licensed in the state or province where the individual
is being treated.”
Botox
2010:308R-H-7
9
10
11
Child’s first visit to dentist, position on
98:24-H-7
12
13
14
"Resolved, that the Academy of General Dentistry ascribes to the American
Dental Association's policy on the prompt payment of dental claims, which reads:
'Resolved, that the appropriate agencies of the American Dental Association,
and its constituent dental societies, be urged to seek legislation which would
require all public and private third-party payers to reimburse dental claims
within (15) business days from receipt of the claim by the third-party payer or
be penalized for failure to do so.'"
Code of procedures, endorsed by AGD
74:12-H-11
24
25
26
27
28
29
30
31
32
33
34
35
“Resolved, that the Academy of General Dentistry officially endorse the position
that a child’s first visit to the dentist should occur within six months of the
eruption of the first tooth.”
Claims, prompt payment of
93:22-H-7
15
16
17
18
19
20
21
22
23
“Resolved, that the AGD supports general dentists receiving education on, and
the performance of botulinum toxin and cosmetic dermal filler procedures.
"Resolved, that the AGD endorse the principle of one code of procedures for
dentistry, and be it further
Resolved, that whenever the ADA Council on Dental Benefit Programs or one of
its sub-committees considers revisions in the ADA code the Academy of
General Dentistry be permitted direct input into such revisions by having
representation at those meetings, and be it further
Resolved, that the AGD urge the American Dental Association to take steps to
assure that the approved code is used throughout the purview of the Academy
of General Dentistry."
Consultant, ground rules for claims denial
93:27-H-7
"Resolved, that when a third-party dental consultant applies an alternative
benefit provision to the treatment plan submitted by the provider dentist, or
when a third-party dental consultant denies benefits for reasons other than
contract exclusions, the dental consultant must sign the report and provide
his/her telephone number, and be it further
16
1
2
3
4
5
6
Resolved, that the AGD promote this concept to the American Dental
Association, the Canadian Dental Association and third-party payment groups."
Co-payment and overbilling, waiver of
93:23-H-7
7
8
9
10
11
12
13
14
15
16
17
18
19
20
'Resolved, that constituent dental societies be urged to pursue enactment of
legislation that:
1)
2)
Corporate Guidelines and Mandates
“Resolved, that the AGD is opposed, as unduly burdensome to general dentistry
and the patients it serves, to all corporate mandates that require specified
quantities of utilization of the corporation’s products in patient’s dental
treatment, without any qualitative assessment of each dentist’s proficiency with
the products and without substantial clinical evidence of patient harm as a result
of utilization in less than the specified quantities, as prerequisites for continued
access to the use of the corporation’s product.
Date of manufacture of dental equipment and devices
81:26-H-7
25
26
27
28
29
30
prohibits systematic non-disclosure of waiver of patient
co-payment/overbilling by a dentist and
prohibits bad faith insurance practices by third party payers, consistent
with Association policy, and be it further
Resolved, that third-party payers be urged to support this legislative
objective.'"
2009:319S-H-7
21
22
23
24
"Resolved, that the Academy of General Dentistry adopt the American Dental
Association's policies regarding waiver of copayment and overbilling, which read:
"Resolved, that AGD encourage that ADA specifications for dental materials and
devices include an expiration date where applicable, and when not applicable a
date of manufacture or packaging, and be it further
Resolved, that the type of date utilized be clearly indicated and separate from
a lot or serial number."
Dental health education for the public
81:33-H-7
"Resolved, that AGD support the concept of having public funds used to support
dental health education for the public."
2006:23R-H-7
“Resolved, that AGD seeks to educate the public about the potential financial &
health risks, due to lack of legal and contractual insurance recourse when medical
& dental care is sought outside of the United States and Canada.”
31
32
17
1
2
Dental hygienists, authority of State Boards of Dental Examiners
92:34-H-7
3
4
5
"Resolved, that because of the nature of dentistry and the manner in which it is
delivered to the public, it is the policy of the Academy of General Dentistry that
dental hygiene should remain under the authority of the various state boards of
dental examiners and that dental hygiene education should remain under the
purview of and be accredited by the Joint Commission on Dental Accreditation."
Dental Implants
2008:317-H-7
“Resolved, that the AGD policy shall be that dental implants are an accepted
modality of treatment.”
6
2009:301S-H-7
“Resolved, that the AGD support legislation requiring insurance carriers to cover
reimbursement for surgical implant placement and restoration.”
2009:306-H-7
“Resolved, that, when one or more dentists are involved in dental implant
therapy, there should be mutual agreement of the restorative objectives by all
parties, including the patient, before any invasive therapy is undertaken.”
7
8
2009:307-H-7
9
10
11
Dental insurance plan to include all facets of dentistry
82:32-H-7
12
13
14
"Resolved, that the AGD support the concept of using public funds if available for
dental research."
Dentistry's position on a National Health Program
80:25-H-7
21
22
23
“Resolved, that the AGD take appropriate action when necessary to ensure
that safe and effective dental materials, products, and/or medications remain
approved for use in oral healthcare.”
Dental research, public funding for
81:35-H-7
18
19
20
"Resolved, that the AGD recognize that an optimum dental benefits plan includes
all facets of dentistry."
Dental products, materials, and medications, opposed to bans on the use of
2010:306RS1-H-7
15
16
17
"Resolved, that the AGD adopt the Educational Objectives for the Provision of
Dental Implant Therapy.”
"Resolved, that AGD's Guidelines for Dentistry's Position on a National Health
Program and other relevant AGD and ADA policy be reviewed in relation to any
future legislation mandating dental benefits."
Dentist's right to collect a larger fee from patient
77:14-H-6
"Resolved, that the AGD is opposed to any administrative procedure by a third
18
party payment mechanism which interferes with the dentist's right to collect
from a patient a fee greater than that allowed by the carrier's benefit structure
except when a dentist has agreed to become a participant in a benefits program
that utilizes a usual, customary, and reasonable method of reimbursement as
payment in full.”
1
2
3
Diagnosis and supervision needed for dental treatment
2003:16-H-7
4
5
6
Diagnostic tests, dentists’ right to prescribe and perform
97:26-H-8
7
8
9
10
11
12
13
14
15
16
17
18
19
20
1.
The test is required for the oral diagnosis of or treatment planning for the
patient, or the management of a percutaneous injury in a clinical setting.
2.
The patient has given informed consent.
3.
The test is accompanied, where appropriate, by adequate pre- and postcounseling.
4.
There is provision for appropriate referral to a physician responsible for
the comprehensive medical care of the patient.”
“Resolved, that the AGD urge dentists to employ environmental “best
management” practices as supported and/or promoted by the American Dental
Association and in Canada by the Canadian Dental Association, and be it further
Resolved, that AGD constituents be encouraged to work with their
counterpart dental societies to adopt and promote environmental best
management practices.”
Expanded Function Dental Assistant (EFDA)
2011:302RS-H-7
28
29
“Resolved, that the Academy of General Dentistry recognizes that dentists have
the right to prescribe and perform any diagnostic tests deemed necessary
providing that:
Environmental “best management” practices
2003:12-H-7
21
22
23
24
25
26
27
“Resolved, that dental treatment, including the placement of dental sealants and
fluoride varnishes, is most effectively and successfully accomplished following a
proper diagnosis by, and under the supervision of a licensed dentist in compliance
with the regulations of the state or province, and in a dental office setting that
ensures optimal treatment outcomes.”
“Resolved, that it is the position of the AGD that the utilization of expanded
function dental assistants (EFDA), under the direct supervision of the dentist,
providing only reversible procedures is an effective, safe and efficient way to
increase capacity and access to care while reducing barriers to utilization of care.”
Evidence-based dentistry
19
1
2
3
Definition of
2000:22A-H-7
4
5
6
Use of
2000:22B-H-7
7
8
9
"Resolved, that the Academy of General Dentistry recognizes that dentists may,
upon occasion, adjust fees to classes of individuals, such as relatives, clergy, staff,
senior citizens, the indigent, and be it further
Resolved, that any occasional fee adjustments should not be reflected in
determination of UCRs by third parties, and be it further
Resolved, that the Academy of General Dentistry recommends that this be
properly recorded in the dentist's records."
Fees; i.e., usual, reasonable, customary: definition of
93:24-H-7
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
“Resolved, that evidence-based dentistry be utilized to promote the delivery of
the most effective care for the patient and not for the determination of dental
benefits.”
Fees, adjustment of
93:25-H-7
10
11
12
13
14
15
16
17
18
“Resolved, that the Academy of General Dentistry believes that evidence-based
dentistry is an approach to treatment planning and subsequent dental therapy
that requires the judicious melding of systematic assessments of scientific
evidence relating to the patient’s medical condition and history, the dentist’s
clinical experience, training, and judgment, and the patient’s treatment needs
and preferences.”
"Resolved, that the Academy of General Dentistry adopt the American Dental
Association's definitions of and policies regarding 'usual, customary and
reasonable fees,' which read:
'Usual fee' is the fee which an individual dentist most frequently charges for a
specific dental procedure.
'Reasonable fee' is the fee charged by a dentist for a specific dental procedure
which has been modified by the nature and severity of the condition being
treated and by any medical or dental complications or unusual circumstances,
and therefore may differ from the dentist's "usual" fee or the benefit
administrator's "customary" fee.
'Customary fee' is the fee level determined by the administrator of a dental
benefit plan from actual submitted fees for a specific dental procedure to
establish the maximum benefit payable under a given plan for the specific
procedure."
First Dental Visit Timing and Establishment of the Dental Home (AAP Policy Proposal)
2002:22-H-7
Resolved, that the Academy of General Dentistry endorses the American
20
Academy of Pediatrics Policy Proposal from the AAP Section on Pediatric Dentistry
entitled “First Dental Visit Timing and Establishment of the Dental Home”, and be
it further
1
2
3
4
5
Resolved, that the Academy of General Dentistry communicate this
endorsement to the American Academy of Pediatrics.”
Flexible Spending
2008:308-H-7
6
7
8
Fluoridated public water supplies, public funding for
81:32-H-7
9
10
11
Freedom of choice provider
"Resolved, that the Academy of General Dentistry actively support "freedom of
choice" legislation permitting patients to freely choose their dentist while
continuing to utilize their full dental benefits, and be it further
Resolved, that the Academy of General Dentistry actively support "any willing
provider" legislation to allow dentists to enroll at any time and to freely
participate in dental third-party programs."
Health care reform
2009:316-H-7
27
28
29
30
“Resolved, that based on the Center for Disease Control’s Recommendations for
Using Fluoride, the AGD adopt the following position statement:
When used appropriately, fluoride is safe and effective in preventing and
controlling dental caries. Regular use throughout life will help protect
teeth against decay. All water supplies, including bottled water, should
have appropriate fluoride levels. All fluoridated items, including
toothpaste, should be used as recommended by your dentist.”
94:30-H-7
20
21
22
23
24
25
26
"Resolved, that the AGD support the use of public funds to assist local and state
governments in seeing that their public water supplies are adequately
fluoridated."
Fluoride in water supplies and toothpaste, position statement
2002:21-H-7
12
13
14
15
16
17
18
19
“Resolved, that the AGD support the expansion of Flexible Spending Account
(FSA) reimbursable health items to include oral health items.”
“Resolved, that the Academy of General Dentistry participate in any legislative
discussions regarding health care reform.”
Health care reform criteria
21
93:28-H-7
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3
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31
32
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34
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44
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46
47
48
49
50
51
"Resolved, that it is the policy of the Academy of General Dentistry that if
dentistry is to be included in any government health care program reform, it
must:
1)
2)
3)
4)
Be adequately funded to provide broad access;
Permit freedom of choice of dentists;
Be based on fee-for-service; and
Assure high quality dental care.
and be it further
Resolved, in any case where dentistry is included in health care reform, the
AGD support the following six recommendations set forth by the American
Dental Association:
1.
Maintain the advantages of the current dental care and dental benefits
system, which would not require inclusion of dental benefits for
population groups currently receiving regular dental care, and which
would not require public sector participation and subsequent cost
transfer. The Association strongly opposes any change in the tax
deductibility of current dental benefit coverage.
2.
Continue existing policy support for a separate, restructured program of
publicly funded dental benefits for indigent persons. Priority
consideration should be given to programs for children. The Association
urges that these programs be administered in the private sector
wherever possible.
3.
For population groups currently not receiving regular dental care the
Association supports the opportunity for a) small employers purchase
dental plans in the private sector, b) development of cooperative dental
benefit purchasing alliances administered in the private sector.
4.
The Association recommends that preventive services and educational
programs for children be included in any health system reform proposal.
Preventive services may include but are not necessarily limited to,
fluoridation of community water supplies, oral prophylaxis and
application of topical fluorides and sealants; dietary fluoride
supplements; restoration of carious teeth; maintenance of space
resulting from the early loss of primary teeth and patient education.
5.
The Association recommends that in the event that a more
comprehensive program is enacted, preventive, diagnostic, emergency
services and basic restorative and periodontal care be included for
children and the elderly.
6.
The Association believes that if the Medicare program is expanded to
include coverage for additional dental health care services, we would
endorse the inclusion of a defined dental benefit plan for the elderly
population. These services would be expressly focused on those elderly
who are in long-term residential care or home-bound. Delivery of these
services should not be compromised by discrimination by category of
provider (physician or dentist)."
22
1
2
3
4
Licensing
Criteria for eligibility
2002:28-H-7
5
6
7
8
9
10
11
12
13
14
15
16
“Resolved, that the Academy of General Dentistry believes that to be
eligible to apply for an initial license to practice dentistry in the United
States or Canada, the candidate must have:
1.)
2.)
3.)
Graduated from a dental college with training that is equivalent or higher
than that provided by a dental college approved by the American Dental
Association’s Commission on Dental Accreditation or the Canadian
Commission on Dental Accreditation,
Passed Part I and Part II of the National Board Exam (or the National
Dental Examining Board Exam in Canada), and
Passed a state or provincial licensing examination, or its equivalent, as
determined by the state or provincial board of dentistry, and any
additional requirements.”
Uniform standards for
2002:27-H-7
17
18
19
20
21
22
23
24
25
26
“Resolved, that the AGD actively support a uniform standard for licensing dentists
in all U.S. states and Canadian Provinces, and be it further
Resolved, that access to oral health care for underserved populations
should be addressed by maintaining uniformly enforced licensing
standards that would prevent an unequal and unacceptable two-tier level of
care, and be it further
Resolved that the AGD believes that access to care in underserved areas
should be solved by instituting adequate financial incentives or loan
forgiveness to properly licensed dentists.”
Voluntary/Temporary Licensing
2009:311-H-7
“Resolved, that the AGD approve the policy Supporting Issuance of
Volunteer/Temporary Licenses for Dentists Licensed in Different States”
“Resolved, that the AGD supports the issuance of a temporary license to do
volunteer dentistry by dental licensing boards to dentists who are licensed in
another state or province when such dentists are seeking such license in order to
provide volunteer or charity care.”
27
28
29
30
31
Medically compromised dental patients
Disclosure of relevant information
88:54-H-7
"Resolved, that all legislation and regulations to protect confidentiality of
information on medically compromised or handicapped patients provide for
23
disclosure of relevant information to members of the individual's direct
care-giving team."
1
2
3
Policy statement on treatment of
88:48-H-7
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5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
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41
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46
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51
"Resolved, that the AGD adopt the following policy:
AGD POLICY STATEMENT ON TREATMENT
OF MEDICALLY COMPROMISED DENTAL PATIENTS
With the aging of the population and the spread of infectious diseases, dentists
will encounter growing numbers of medically compromised patients, including
those with infectious diseases. The general dentist, as primary dental care
provider, plays the key role in providing and coordinating dental care for such
patients.
In this role dentists have responsibilities to all patients, staff and other parties
which they are ethically bound to fulfill.
Responsibilities to the Medically Compromised Patient
o
To treat the patient with kindness and compassion, regardless of the
nature of the patient's condition.
o
To be sufficiently educated to evaluate the dental health of a medically
compromised patient and to consult with physicians, when necessary,
regarding the patient's medical status.
o
To provide appropriate treatment within the dentist's realm of
competence.
Responsibilities to Dental Staff
o
To ensure that staff are trained in emergency care, the management of
special health conditions and the management of medically
compromised patients.
o
To advise staff of the health status of each patient so they may employ
appropriate procedures and avoid procedures that may place themselves
or the patient at unnecessary risk.
o
To ensure that all staff members are properly educated so they
understand that infection control measures, including barrier techniques
are in place and practiced routinely to protect them against disease.
With this understanding they can properly render compassionate care to
a medically compromised patient.
Responsibility to Other Parties
o
Dentists must observe state and/or federal laws and regulations that
require providers to protect the confidentiality of the patient.
Ethical Considerations for Treating HIV Positive Patients
24
1
2
3
4
5
6
7
The AGD believes that dentists are obligated to observe the American Dental
Association's Principles of Ethics and Code of Professional Conduct in the
treatment of all patients including those who are medically compromised, of
which HIV positive patients are a part."
Medically indigent, support programs for
77:18-H-6
"Resolved, that every effort be made to have indigent dental care programs
structured so that they take into consideration the current cost basis involved in
providing the dental services."
81:31-H-7
"Resolved, that AGD support viable programs to provide dental care to the needy
elderly and medically indigent."
81:34-H-7
"Resolved, that the AGD support the concept of using public funds if available to
provide dental care for the medically indigent."
8
9
10
11
12
Medicare, amendment to reimburse dentists for rendering same service as a physician
79:28-H-6
13
14
15
Nutrition and oral health
2004:14-H-7
16
17
18
19
20
21
22
23
24
25
26
27
28
29
"Resolved, that the AGD support the concept of amending Medicare so that a
dentist shall be reimbursed for a dental service rendered under this program if a
physician would have been reimbursed for rendering the same service."
“Resolved, that the Academy of General Dentistry encourages dentists to
maintain ongoing knowledge of nutritional recommendations such as in the
Dietary Guidelines for Americans published by the U.S. Department of Agriculture
and the U.S. Department of Health and Human Services and their Canadian
counterparts, as they relate to general and oral health and disease, and be it
further
Resolved, that the Academy of General Dentistry encourage dentists to effectively
educate and counsel their patients about proper nutrition and oral health, including
eating a well balanced diet and limiting the number of highly cariogenic betweenmeal snacks, and be it further,
Resolved, that the Academy of General Dentistry encourage constituent academies
to work with school officials to ensure that school food services, including vending
services and school stores, provide nutritious food selections, and be it further
Resolved, that the Academy of General Dentistry opposes targeting children
in the promotion and advertisement of foods low in nutritional value and
highly cariogenic foods and beverages and be it further
25
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2
3
4
5
6
7
8
9
10
Resolved, that the Academy of General Dentistry encourages continued federal
support for programs that provide nutrition services and education for infants,
children, pregnant women and the elderly, and be it further,
Resolved, that the Academy of General Dentistry encourages the appropriate
government agencies to prevent the distribution of non-nutritious and highly
cariogenic foods and beverages under federal nutrition service programs.”
Oral Conscious Sedation, position statement
2005:2R-H-7
“Resolved, that the AGD position on Oral Conscious Sedation is:
1. The Academy of General dentistry believes that the general dentist must have
access to appropriate training in the area of anxiolysis and oral conscious
sedation. The AGD further believes that continuing education opportunities
must continue to be developed to make these courses available to the general
practitioner.
2. “Anxiolysis” means removing, eliminating or decreasing anxiety. This may be
accomplished by the use of medication that is administered in an amount
consistent with the manufacturer’s current recommended dosage and/or
judgment on the part of the clinician with or without nitrous oxide and
oxygen. When the intent is anxiolysis only, the definition of enteral and/or
combination inhalation-enteral conscious sedation (combined conscious
sedation) does not apply.
3. The Academy of General Dentistry supports the rights of the general dentist
to use professional judgment in deciding the appropriate dose for each
patient situation, respecting safe dosing parameters.
4. The Academy of General Dentistry believes that each constituent should be in
close contact with their licensing boards to communicate the AGD’s position
on this issue.”
11
12
13
Parameters of care, ADA
91:46-H-7
"Resolved, that the Board be directed to take a firm position that protects and
accurately represents the interests of practicing general dentists on the
development of parameters of care prior to consideration by the ADA House of
Delegates after weighing all available evidence on the issue, including input from
the Chairman of the AGD Dental Practice Council."
14
26
1
2
Parameters of care, criteria for
93:26-H-7
3
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5
6
7
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20
Condition-based;
2.
Equally applicable to all dental care providers;
3.
Universally accepted with the dental profession; and
4.
Developed by the American Dental Association with appropriate
representation by the affected communities of interest, including the
AGD as the representative of general practitioners; and be it further
Resolved, that the AGD reserves the right to develop its own parameters
should the need arise."
"Resolved, that any parameter of care established for the entire dental
profession should be:
1.
Condition-based;
2.
Equally applicable to all dental care providers;
3.
Universally accepted within the dental profession; and
4.
Developed by the American Dental Association with appropriate
representation by the affected communities of interest, including the
AGD as the representative of general practitioners; and be it further
Resolved, that the AGD's Dental Practice Council shall continue to monitor the
status of parameters and attempt to achieve AGD representation in the
development of parameters, and be it further
Resolved, that the AGD reserves the right to develop its own parameters or
oppose the development of parameters should the need arise."
Preferred Provider Organizations
84:26-H-7
41
42
43
1.
Resolved, that the AGD's Dental Practice Council shall continue to monitor the
status of parameters and attempt to achieve AGD representation in the
development of parameters, and be it further
94:32-H-7
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
"Resolved, that any parameter of care established for the entire dental
profession should be:
"Resolved, that the Academy of General Dentistry use whatever means are
available to ensure that the following provisions are included in and made a part
of any state and/or federal law mandating and/or regulating preferred provider
organizations:
A.
Patients' freedom of choice of provider must be guaranteed.
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8
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23
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32
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36
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39
40
41
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44
45
46
47
48
Preferred provider policies or contracts and preferred provider
subscription contracts shall provide the same benefits level to the
patient whether rendered by non-preferred providers or preferred
providers.
C.
No dentist willing to meet the terms and conditions offered by a PPO
shall be excluded.
D.
All types of licensed health care providers whose services are required
shall have the same opportunity to qualify for payment as a preferred
provider under any such policies.
E.
The terms and conditions of any PPO policies or contracts shall not
discriminate against or among health care providers.
F.
A preferred provider subscription contract should be defined as a
contract which specifies how services are to be covered by the plan
when rendered by non-participating providers and by preferred
providers.
G.
Preferred provider policies or contracts should be defined as insurance
policies or contracts which specify how services are to be covered by
the plan when rendered by preferred and non-preferred providers.
H.
When preferred provider organizations are promoted to the public,
they cannot do so with any implications of superiority, and all
promotional materials used by PPOs must state if a preferred provider
is a reduced fee contract.
I.
The PPO shall make provision for a periodic adjustment in level of
reimbursement based on the Consumer Price Index or some other
equitable basis.
And be it further
Resolved, that the Academy of General Dentistry encourage its Constituent
Academies to work toward building these safeguards into any state and/or
federal law mandating and/or regulating preferred provider organizations.
And be it further
Resolved, that the Academy of General Dentistry transmit this position to the
American Dental Association's Council on Dental Care Programs."
Prepayment plans
Bill payer system
78:24-H-6
49
50
B.
"Resolved, that the AGD recognize the 'bill payer system' (direct reimbursement)
as one of the acceptable forms of dental prepayment."
Exclude certain contract language
28
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77:12-H-6
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4
5
6
7
8
9
10
11
12
13
14
Resolved, that such language be eliminated from prepayment contracts
wherever possible, and be it further
Resolved, that this type of language in existing dental contracts be
implemented in such a manner so as not to impugn the integrity of the
attending dentist or intrude upon the patient-dentist relationship by either
informing or implying that an alternate mode of treatment is appropriate, or
influence the patient in any way in his choice of the attending dentist's
treatment.”
Include all phases of preventive dental services
81:29-H-7
15
16
17
18
19
20
21
Structuring of dental prepayment programs
"Resolved, that third party mechanisms, including government programs, take
these differences into consideration in structuring dental prepayment programs,
and be it further
Resolved, that dental prepayment programs for the non-indigent have a
provision whereby the patient will pay the differences between the fee
authorized under the program and the normal fee charged."
Public information available to public of dental office safety
92:30-H-7
29
30
31
32
33
34
35
36
"Resolved, that the AGD recognize the necessity of having all phases of
preventive dental services in the dentist's office included in dental prepayment
plans, and be it further
Resolved, that AGD request the appropriate agencies of the American Dental
Association to consider the development of a position statement that would
serve to accomplish this purpose."
77:17-H-6
22
23
24
25
26
27
28
"Resolved, that in the interest of providing the best possible level of dental care
for the patient, the Academy of General Dentistry is opposed to the inclusion of
'least expensive but adequate treatment', 'alternate mode of treatment', or
similar contract language, in prepayment dental plans, and be it further
"Resolved, that the Academy of General Dentistry believes that any
advertisement of the HIV status of the dentist or any member of the dental team
is misleading to the dental consumer
and be it further
Resolved, that all members and dental personnel are encouraged to work to
educate the public and all patients on the safety of dental procedures and the
precautions taken by dental professionals to safeguard patients' health in the
dental office."
29
1
2
Resource-Based Relative Value Scale
89:53-H-7
3
4
5
Rights of employers to provide health care benefits
80:24-H-7
6
7
8
9
10
11
School curricula – oral health education
“Resolved, that the Academy of General Dentistry advocates incorporation of oral
health education into primary and secondary school curricula with measurable
outcomes, as a proven and cost effective disease prevention and universal health
promotion program.”
Soft drink consumption/pouring rights contracts
2004:13-H-7
15
16
17
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19
20
21
22
23
24
25
26
27
"Resolved, that AGD agrees in principle with the traditional rights of all employers
to provide health care benefits for their employees, and be it further
Resolved, that AGD continue its dialogue with the ADA to clarify any proposal
to provide dental benefits to federal employees."
2002:23-H-7
12
13
14
"Resolved, that the Academy of General Dentistry opposes use of the
Resource-Based Relative Value Scale as a method of determining payment for
services provided by dentists."
“Resolved, that the Academy of General Dentistry, through its appropriate
agencies, continue to review the supporting data concerning the oral health
effects of the increasing consumption of beverages containing sugars,
carbonation or acidic components. These products are commonly referred
to as “soft drinks,” including but not limited to juice drinks, sports drinks
and soda pop, and be it further
Resolved, that the Academy of General Dentistry encourages its constituents to
work with education officials, pediatric and family practice physicians, dietetic
professionals, parent groups, and other interested parties, to increase the
awareness of the importance of maintaining healthy vending choices in schools,
and to encourage the promotion of fluoridated water and beverages of high
nutritional value, and be it further
Resolved, that the Academy of General Dentistry opposes contractual arrangements,
including pouring rights contracts, that influence the consumption patterns that
promote increased access to ‘soft drinks’ for children.”
Supervision, definitions of for dental hygienists and other dental auxiliaries
85:27-H-7
"Resolved, that the Academy of General Dentistry believes that a dental hygienist
or other dental auxiliary, in accordance with their training and education, and
state law, shall, under a dentist's supervision, perform those aspects of treatment
delegated by that dentist; and be it further
28
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7
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Resolved, that the setting in which a dental hygienist or other dental auxiliary
may perform legally designated functions shall be a treatment facility under
the jurisdiction and supervision of a licensed dentist; and be if further
Resolved, that the AGD shall use the following definitions of 'supervision':
General Supervision means that the dentist has authorized the
procedures and they are being carried out in accordance with his/her
diagnosis and treatment plan.
Indirect Supervision means that the dentist is in the dental office,
authorizes the procedure and remains in the dental office while the
procedures are being performed by the auxiliary.
Direct Supervision means that the dentist is in the dental office,
personally diagnoses the condition to be treated, personally authorizes
the procedure and before dismissal of the patient, evaluates the
performance of the dental auxiliary.
Personal Supervision means that the dentist is personally operating on a
patient and authorizes the auxiliary to aid his/her treatment by
concurrently performing a supportive procedure."
2008:321-H-7
24
25
26
27
28
29
Surgeon General's Report on Oral Health
Implementation plan
2001:26-H-8
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
“Resolved, that the AGD define and incorporate into existing policies the
definition of dental auxiliaries to include midlevel practitioners and all other
individuals who are not licensed dentists, but otherwise provide oral health care.”
“Resolved, that it is the role of the Academy of General Dentistry to
implement the Surgeon General’s Report on Oral Health by:
1.
2.
Expanding the demand for and availability of dental continuing
education opportunities that:
a.
Address the management of the oral health needs of at-risk
toddlers, children, special needs, and geriatric patients.
b.
Expand the knowledge of practicing dentists in the areas
of oral medicine and the relationships between oral health
and general health.
Working with other health care organizations to expand and elevate
the knowledge of health care professionals, policy-makers, and the
public (with an emphasis towards underserved communities) about:
31
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8
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15
16
3.
a.
The relationships between oral health and general health.
b.
Oral disease prevention measures including home care,
nutrition, fluoride, sealants, and tobacco cessation.
c.
Promoting oral health in school curricula.
Advocate the development and implementation of appropriate
proactive measures that will improve access to dental care (such as
student loan forgiveness, tax credits and/or incentives to induce
recent dental school graduates to practice in underserved areas).”
Third party mechanisms
ADA's role in problems with
81:27-H-7
17
18
19
20
21
22
23
24
25
"Resolved, that the AGD recognize the American Dental Association's appropriate
role in communicating with third party payment mechanisms for the purpose of
upholding prepayment standards which have been agreed upon by the
profession, and be it further
Resolved, that all complaints involving third party payment mechanisms taking
more than 30 days to reimburse patients or dentists for dental services
rendered be referred to the ADA so that appropriate dialogue may be
instituted with the third party on behalf of the public and the dental
profession."
Claim contested by dental consultant of
75:30-H-10
26
27
28
"Resolved, that should a patient's claim be contested by the third party's dental
consultant, patient, or the patient's dentist, it shall be submitted to the local level
of organized dentistry's peer review system and the third party, the patient, and
the dentist should agree that the action of the peer review system is binding."
Considerations in deliberating dental health insurance programs
74:8-H-11
"Resolved, that the Academy of General Dentistry take into consideration the
needs of the public, the various third party pre-payment mechanisms, and the
entire dental profession in deliberating on dental health benefits programs which
might be of concern to the general dentists which compose its organization."
29
32
1
2
3
Consultant of, should make no representation to patient regarding dentist's
service or fee
75:29-H-10
4
5
6
"Resolved, that when a patient's claim is considered for modification, and/or
review, the third party dental consultant should contact the patient's dentist to
discuss the matter fully rather than making any representation to the patient
with respect to the dentist's services or fees."
Diagnostic imaging
94:15-H-7
7
8
9
"Resolved, that the Academy of General Dentistry supports third-party
reimbursement for all forms of diagnostic imaging determined to be medically
necessary by the treating dentist and supported by appropriate clinical criteria."
Differentials in levels of reimbursement in
77:13-H-6
10
11
12
13
14
"Resolved, that the Academy of General Dentistry is opposed to differentials in
levels of reimbursement in third party programs based on whether or not a
practicing dentist is a 'participating' or 'non-participating' dentist in such a
program, and be it further
Resolved, that this resolution be communicated to the ADA, Delta Dental Plans,
and all of the participating Delta Dental Plans in every state in the United
States."
86:34-H-7
15
16
17
18
"Resolved, that the AGD is unequivocally opposed to any type of separate fee
schedules for reimbursement to general practitioners and specialists for the same
or similar services.”
Fee Determination
2009:317RS-H-7
“Resolved, that third party payers should not determine fees for procedures not
covered and/or not reimbursed in their policies. And be it further,
Resolved, that the appropriate AGD agencies be directed to help AGD
constituents develop legislation that will prevent third party payers from setting
fees for non-covered and/or non-reimbursed procedures.”
19
20
21
Fee schedules based on utilization reviews considered arbitrary
2000:25-H-7
22
23
24
“Resolved, that the Academy of General Dentistry believes that any fee schedule
by third party dental benefit administrators or other entities that separates
dentists into different payment levels as determined by statistically based
‘utilization reviews’ is arbitrary, discriminatory, and not consistent with
appropriate patient care.”
Guidelines for handling members’ problems with
33
75:33-H-10
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12
13
"Resolved, that the AGD adopt the following guidelines for handling
communications from members on their problems with third party programs:
a.
All complaints must be placed in writing and be sufficiently documented.
b.
The executive director, in consultation with the Dental Practice Council
chairman, shall be charged with the responsibility of corresponding
directly with those carriers that are acting in opposition to policy
previously established by the AGD.
c.
The AGD should seek the help of the American Dental Association on
those complaints involving a violation in ADA policy."
Not to interfere with dentist's diagnosis and treatment
75:32-H-10
"Resolved, that the AGD recognize a third party payment mechanism's
responsibility to determine its liability and extent of dental benefits but is
unalterably opposed to any administrative procedure that interferes with the
attending dentist's diagnosis and treatment plan."
86:33-H-7
"Resolved, that alternative payment systems for all dental care delivery should
not infringe upon the right and responsibility of the licensed practicing dentist to
diagnose and treat patients according to the proper standard of care."
14
15
16
17
Overpayment recovery practices
2003:13-H-7
18
19
20
21
22
23
24
25
26
“Resolved, that the Academy of General Dentistry seek and support efforts
opposing third party overpayment recovery practices, except as contractually
obligated, when the overpayment was the result of a mistake made by the insurer
and accepted by the dentist in good faith without prior or reasonable knowledge
of the error, and be it further
Resolved, that the Academy of General Dentistry seek and support efforts to
prevent third party payers from withholding fully assigned benefits to a dentist
when an incorrect payment has been made to the dentist on behalf of the
subscriber with the same third party payer.”
Participation should not be contingent upon participation in government
regulated programs
97:30-H-8
“Resolved, that retention of a license to practice dentistry and participation in
third party plans should not be contingent upon participation in government
regulated programs.”
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34
1
2
Reduction/denial of dental benefits must be signed by licensed dentist
2000:26-H-7
“Resolved, that the Academy of General Dentistry believes that any third party
reduction or denial of dental benefits on the basis of ‘not medically necessary or
appropriate’ must be made on an individual basis and signed by a dentist licensed
in the state or province in which the procedures are being performed, and be it
further
3
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5
6
7
8
9
10
11
12
13
14
15
16
Resolved, that the Academy of General Dentistry believes that any third party
reduction of dental benefits on the basis of ‘least expensive alternative
treatment’ be made on an individual basis and signed by a dentist licensed in
the state or province in which the procedures are being performed, and be it
further
Resolved, that the Academy of General Dentistry believes that any review of
clinical records for the purpose of reducing or denying dental benefits must be
made on an individual basis and signed by a dentist licensed in the state or
province in which the procedures are being performed.”
Regulated by law or state governmental agency
85:23-H-7
17
18
19
Tissue biopsy
2006:25-H-8
20
21
22
“Resolved, that it is the position of the AGD that the decision whether or not to
biopsy oral tissues lies within the purview of the treating dentist.”
TMD policy statement
86:29-H-7
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24
25
26
27
28
29
30
"Resolved, that the Academy of General Dentistry support legislation and rules
and regulations that would require third-party mechanisms selling dental benefits
programs based on UCR in a state, to use data that is not more than six months
old on the date of filing, and so state this date in published material to users and
prospective users of these programs; and be it further
Resolved, that the AGD communicate the problems being addressed by this
resolution to the ADA's Council on Dental Benefit Programs to seek a viable
solution; and be it further
Resolved, that the AGD's Dental Practice Council solutions being offered by the
ADA to see if further action by the AGD is needed."
89:55-H-7
31
32
33
34
"Resolved, that all third-party payment mechanisms be regulated by law or
through the appropriate state governmental agency to ensure fiscal responsibility
and protection of the interests of the public."
"Resolved, that the Academy of General Dentistry's TMD Policy is:
1.
The existence of TM orders is undeniable and these disorders can be
treated by the general dentist.
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4
5
6
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22
23
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26
27
Like any disorder or disease, the indication for TMD treatment is a
doctor/patient decision. The criteria for this decision is both subjective
and objective.
4.
It is not possible to list all the effective (and thus reimbursable) TMD
procedures. It is the application of clinical judgment which determines
the appropriate treatment modality.
TMJ
Medical care contracts should not discriminate against dentists
"Resolved, that in cases where dentists provide their expertise in treatment of
temporo-mandibular joint dysfunction and cranio-mandibular disorders, medical
care contracts should not discriminate in benefit payments based on the
professional degree of the provider."
Tooth numbering system
"Resolved, that the Academy of General Dentistry endorses the universal (1 to
32/a to t) tooth numbering system adopted by the ADA and encourage its
immediate implementation through the American Dental Association and the
American Dental Education Association and other segments of the dental
profession."
Untoward responses to products, materials, and medications
98:23-H-7
34
35
36
3.
Resolved, that the Academy of General Dentistry support the concept that
comprehensive policies or certificates of health, medical, hospitalization, or
accident and sickness insurance should provide reimbursement for the
diagnosis and therapeutic treatment of temporomandibular
dysfunction/myofascial pain dysfunction and associated diseases and
dysfunctions and that benefit coverage be the same as that for treatment of
any other joint in the body and be applicable if the treatment is administered
or prescribed by a physician or a dentist.”
81:28-H-7
31
32
33
There are a variety of viable diagnostic and treatment modalities for TM
disorders, as there are in the treatment of physiological disorders, back
problems, and many other medical maladies.
and be it further
88:52-H-7
28
29
30
2.
“Resolved, that the Academy of General Dentistry encourage its members to be
aware of possible untoward responses to products, materials, and/or
medications used in the dental office, and that the use of these products,
materials and/or medications will be up to the discretion of the treating
provider.”
Workforce, adequacy of present dental workforce
2002:26-H-7
“Resolved, that the Academy of General Dentistry adopt the following statement
36
relative to the adequacy of the dentist workforce in 2002:
1
2
3
4
5
6
7
8
9
10
The dentist workforce in the United States is sufficient to meet the needs of
the public demand for dental services. Geographic imbalances exist in
localized areas due to a variety of factors. Where these imbalances result in
shortages, the affected regions must be examined and addressed individually
for appropriate solutions. The development of a responsive, competent,
diverse, and “elastic” workforce should address potential increases in demand
for dental services.”
Work force issues, position statement
2005:3-H-07
“Resolved, that the Academy of General Dentistry’s position in response to work
force issues is:
 AGD believes that access to oral health care is an issue that needs to be
addressed throughout the profession.
 AGD believes that general and pediatric dentists, working in concert with
the dental team, are the gatekeepers of oral health.

11
12
13
14
15
Dental Practices
Open elections and nominations for officers
78:23-H-6
16
17
18
19
20
21
AGD believes that general dentists are uniquely qualified to help provide
and maintain the optimal standard of care.”
"Resolved, that all dental service corporations be requested to have open
elections and nominations for officers and members of the Board involving all of
its participating dentists so as to give the participating dentists representation in
matters relating to improvement of patient services and maintaining high
professional standards, and be it further
Resolved, that this resolution be conveyed to the ADA House of Delegates for
implementation."
To be owned and operated by licensed dentists
86:32-H-7
AMENDED HOD 2009
2009:300-H-7
“Resolved, that policy 86:32-H-7 be amended so that it reads:”
22
86:32-H-7 “Resolved, that the AGD recognize that the public is best served when
dental practices (those traditional fee for service private practices or
any alternative compensation system of practice) are owned and
operated by dentists licensed in the state or province of such
37
ownership or operation, and be it further
Resolved, that the AGD supports the inclusion of language in state
dental practice acts that would prohibit a party or parties not licensed
to practice dentistry from becoming involved in the ownership or
control of dental practices with an exception allowing for the nondentist survivor or designee of a deceased dentist to retain ownership
of the dental practice in order to facilitate an orderly transfer of
patient records to a new dentist owner or licensed dental practice
with ownership to remain in effect until an orderly transfer can occur
or a two year period from the death of the original dentist owner.”
1
2
3
4
5
6
Dental Students
Financial assistance to, that restricts choice of geographical location of practice
76:50-H-11
7
8
9
"Resolved, that the AGD oppose any form of federal assistance to dental schools
or dental students that restricts the freedom of graduates of dental schools to
voluntarily choose the type or the geographical location of their practices, as long
as they are able to meet the appropriate state licensing requirements."
Loan program for
81:23-H-7
"Resolved, that AGD recognize the need for the dental profession to offer input
into a fair and equitable loan program for dental students, supported by both
private and public funds."
81:36-H-7
"Resolved, that AGD recognize the need to have the federal government involved
in providing loans to dental students with the provision that all such funds be
paid back with appropriate interest."
10
11
12
13
Recruiting highly qualified students
87:56-H-7
14
15
16
Denturism
85:24-H-7
17
18
19
"Resolved that the AGD urge its constituent Academies to continue their
involvement with dental schools and alumni associations in recruiting highly
qualified students for dental schools."
"Resolved, that in the interest of the health of the public, the Academy of General
Dentistry supports the need of the dentists to be appropriately involved in all
dental and oral prosthetic care rendered directly to patients, and as such,
opposes the denturism movement."
Direct Reimbursement
38
1
2
Definition of
90:56-H-7
3
4
5
6
7
8
9
10
"Resolved, that 'direct reimbursement' be defined as follows:
'Direct reimbursement is a self-funded program in which the individual is
reimbursed based on a percentage of dollars spent for dental care provided,
and which allows beneficiaries to seek treatment from the dentist of their
choice.'"
Promotion of
85:28-H-7
"Resolved, that the Academy of General Dentistry continue its support of the
American Dental Association's efforts and activities to promote direct
reimbursement throughout the country."
97:27-H-8
“Resolved, that the Academy of General Dentistry is in support of and offers
encouragement to the ADA in its efforts to promote direct reimbursement.”
11
12
13
14
15
16
Dues
Assessment
81:48-H-7
"Resolved, that the Board include an enumeration of any portion of the
membership to be suggested for exemption from a future assessment along with
its complete rationale for any assessment to be considered in the future by this
House of Delegates."
2005:13H-H-7
Resolved, that the Academy of General Dentistry recommends that dentists
receive training on the recognition and evaluation for signs and symptoms
consistent with abuse and/or neglect.
17
18
19
20
Enteral Conscious Sedation
2006:1-H-8
21
22
23
24
25
26
27
28
29
30
31
32
33
“Resolved, that the AGD adopts as policy, the White Paper on Enteral Conscious
Sedation.”
Federal Services
2012:304-H-6
“Resolved, that the Barriers and Solutions to Accessing Care be adopted as AGD
HOD policy.”
2012:305-H-6
“Resolved, that the AGD believes that charitable foundations such as Pew
Charitable Trusts (Pew) and the W.K. Kellogg Foundation (Kellogg) should focus
their resources to fund the solutions that are identified by the AGD, including the
solutions contained within the AGD White Paper on Increasing Access to and
Utilization of Oral Health Care Services (White Paper), to improve the status of
oral health in underserved and vulnerable populations, and be it further,
39
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2
3
4
5
6
7
8
9
10
11
12
Resolved, that the appropriate entity or entities of the AGD determine the
feasibility, advisability and when appropriate, the mechanism and timing, to
engage charitable foundations such as Pew and Kellogg with the purpose of
seeking funding for the solutions that are identified by the AGD including specific
solutions that are contained within the AGD White Paper with regard to
improving the status of oral health in underserved and vulnerable populations,
and be it further,
Resolved, that the appropriate entities report back progress to the 2013 HOD.”
Benefits for military personnel and their dependents
81:38-H-7
13
14
15
16
17
18
19
20
21
Resolved, that these dental services shall be provided by the private sector
where possible, and be it further
Resolved, that the AGD work to have provisions under which these services are
to be provided conform to AGD policy."
Salary reimbursement for military dentists
81:25-H-7
22
23
24
25
26
27
28
29
30
"Resolved, that AGD recognize that factors such as the following items should be
taken into consideration in the salary reimbursement for federal service dentists:
o
o
o
o
o
o
91:50-H-7
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33
34
35
36
37
38
39
40
41
42
43
44
"Resolved, that the AGD support the concept of enhancing the benefits offered to
individuals serving in the military by providing dental services for their
dependents, and be it further
the amount of education acquired by the dentist
the proficiency of the dentist
the level of experience of the dentist and the individual's ability to
handle the more complex dental procedures in a competent manner
status, rank, or duties within the group
tenure
the cost of living in one geographical area as opposed to another."
"Resolved, that the salaries for physicians and dentists in the Federal Services
should be determined by the following factors:
1.
The scope of responsibility which may be determined by rank, title, etc.
2.
The degree of education which may include specialty training, general
practice residencies, advanced educational programs in general
dentistry, passage of a certifying board, etc.
3.
A relationship with the remuneration generally earned by that
profession within the practicing civilian sector.
4.
Length of service."
Special pay for uniformed services
93:31-H-7
"Resolved, that the Academy of General Dentistry support the upgrading of
40
special pay for dentists in the federal uniformed services, and that this position
be properly communicated to the American Dental Association."
1
2
3
4
5
Fees
Adjusted for complying with governmental regulations
92:35-H-7
6
7
8
9
10
11
12
13
Resolved, that dentists may charge a separate fee or adjust current fees to
cover these costs."
General Dentist
Continued competency
94:24-H-7
14
15
16
17
18
19
20
21
22
23
24
25
26
"Resolved, that assuring the public of the dental profession's continued
competency is best addressed by appropriate continuing dental education,
effective peer review, and the proper enforcement of the dental practice acts by
the state and provincial boards of dental examiners, and be it further
Resolved, that the AGD of General Dentistry continue to express this position
by letter to members of the American Association of Dental Examiners
Continued Competency Committee and the American Association of Dental
Examiners Executive Council before the final presentation of the Continued
Competency report, and be it further
Resolved, that the Academy of General Dentistry express this position by letter
to the American Dental Association, the American Dental Education Association
and all other individuals and organizations that would be affected by or have
influence on this issue."
Creed of
84:17-H-7
27
28
29
30
31
32
33
34
35
36
37
38
39
"Resolved, that the Academy of General Dentistry recommends that dentists may
incorporate into their normal overhead the cost of complying with OSHA, CDC
and other government regulations, and be it further
"Resolved, that the Academy of General Dentistry establish a creed for the
purpose of more closely identifying the organization with a philosophy and code
of conduct, and be it further
Resolved, that the following five statements be adopted as the AGD creed:
1.
To educate myself to perform with greater ability.
2.
To provide and promote the best treatment for my patients.
3.
To treat my patients with continued dignity and empathy.
4.
To share my knowledge with my patients and my profession.
5.
To maintain my integrity and professionalism.
41
1
2
3
4
5
6
7
And be it further
Resolved that if feasible, the AGD creed be included on the back of the AGD
membership cards and used in such other ways determined to be appropriate."
Coordinate and manage dental health
82:22-H-7
8
9
10
"Resolved, that the AGD recognizes that it is in the best interest of the public for
the general dentist to coordinate and manage the oral health care needs of all
patients."
Definition of
2009:310-H-7
“Resolved, that the AGD amend policy 2008:319S-H-7.
“Resolved, that Policy 2007:303-H-7 be amended so that it reads:
2007:303-H-7 “Resolved, that AGD defines a general dentist as 'An individual who
has successfully completed formal dental training leading to a DDS, DMD, or
comparable degree which qualifies that individual to be a dentist and to accept
the professional responsibility for the diagnosis, treatment, management, and
overall coordination of services that meets patients' oral health needs, and who
has not announced a limitation of practice to any of the specialty areas
recognized by the American Dental Association,’ and be it further
Resolved, that the AGD defines 'primary dental care provider' as 'the general or
pediatric dentist who accepts the professional responsibility for the treatment of
the patient and/or the management and coordination of services to meet the
patient's oral health needs, consistent with the ADA Principles of Ethics and Code
of Professional Conduct.”
11
12
13
Primary dental care provider, defined
95:8-H-7
14
15
16
"Resolved, that the AGD define 'primary dental care provider' as 'the general or
pediatric dentist who accepts the professional responsibility for the treatment of
the patient and/or the management and coordination of services to meet the
patient's oral health needs, consistent with the ADA Principles of Ethics and Code
of Professional Conduct.'
Primary entry point into dental care system
75:38-H-10
"Resolved, that the AGD endorse the concept of having the patient's entry level
into the dental health care delivery system be through the general practitioner,
and be it further
17
42
1
2
3
4
Resolved, that it be the general practitioner's prerogative to determine when
and if a patient should be referred to another source for his dental treatment,
and be it further
82:21-H-7
5
6
7
8
9
10
11
12
Resolved, that the AGD advocate this position in programs involving federal
and state governments as well as insurance companies so that optimal dental
health care will be more readily available to larger segments of the public at
less cost."
General Practice Residency Program
79:32-H-6
13
14
15
16
17
18
19
20
21
22
"Resolved, that the AGD recognizes that it is in the best interest of the public for
the general dentist to be the primary entry point into the dental care delivery
system."
"Resolved, that the AGD support general practice residency programs, and be it
further
Resolved, that the AGD recommend that a significant portion of the content of
all general practice residency programs be devoted to but not limited to
experience in a hospital environment, and be it further
Resolved, that the AGD recognizes the concept of and the need for the general
dentistry residency."
Commission on accreditation urged to require that directors of GPR's be general dentists
80:33-H-7
"Resolved, that the ADA Commission on Dental Accreditation be urged to require
that, in the future, the directors of general practice residency programs and
advanced educational programs in general dentistry be well-qualified general
dentists."
23
24
25
Geriatric Care
76:54-H-11
26
27
28
29
30
Health Planning
Organized dentistry to provide input for
81:39-H-7
31
32
33
34
"Resolved, that the AGD recognizes the importance of dental care for the
geriatric patient, and recommends that constituent academies through state
dental societies institute whatever means necessary to inform the geriatric
patient of the importance of regular dental care, and to aid in the providing of
that care to economically disadvantaged geriatric patients."
"Resolved, that the AGD recognize the need for appropriate health planning, and
be it further
Resolved, that the AGD support the concept of organized dentistry having
input into health planning, and be it further
43
1
2
3
4
5
6
7
Resolved, that the AGD support the concept of using local funds for health
planning, and, when necessary, state and federal funds."
HIV
HIV-infected patients, policy on
88:50-H-7
8
9
10
11
12
13
"Resolved, that the AGD regards HIV-infected patients as medically compromised
individuals with an infectious disease who deserve the most considerate and
scientifically sound dental care available and be it further
Resolved, that the AGD opposes dental care discrimination against any
individual, including those with infectious diseases."
Statement on disclosure and infection control
91:51-H-7
REVISED
HOD 7/99
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
"Resolved, that the Academy of General Dentistry strongly supports the validity
and use of universal precautions and appropriate sterilization procedures as
techniques that greatly reduce the risk of transmission of the Hepatitis (HBV) and
Human Immunodeficiency (HIV) viruses between health care workers and
patients, and be it further
Resolved, that the AGD supports voluntary testing of health care providers for
HBV and HIV in the appropriate settings, but opposes mandatory testing
because it is impractical and ultimately ineffective as a preventive measure,
and be it further
Resolved, that dentists and other health care personnel who believe they are
infected with HIV or HBV should obtain medical advice and, if found to be
infected, should act upon that advice and submit to regular medical
supervision, and be it further
Resolved, that the AGD work to educate the public on the safety of dental
procedures and the techniques used by dental professionals to safeguard
patients' health.”
Implants
91:47-H-7
"Resolved, that the AGD House of Delegates agrees that oral implant therapy can
be an acceptable mode of clinical treatment when indicated.”
96:53-H-7
"Resolved, that as an adjunct to the AGD's existing policy with regard to the
consideration of implant dentistry as a specialty, that the following principles be
adopted:
31
32
33
34
35
36
37
38
1. The AGD actively supports the policy that all qualified dentists be permitted
to perform all aspects of implant dentistry including placement and
restoration.
2. The AGD believes that it is in the public's best interest that oral implantology
not be limited to one discipline of dentistry.
44
1
2
3
4
5
6
7
8
9
3. The AGD opposes the implication that specialists performing oral implants
are also specialists in implantology
4. The AGD opposes any marketing efforts that imply any provider of implants
is a qualified oral implantology specialist
Pre-doctoral education
92:32-H-7
10
11
12
13
14
15
16
17
"Resolved, that the AGD support pre-doctoral education in the diagnosis,
placement and restoration of oral implants in the curricula of all dental schools,
and be it further
Resolved, that this resolution be transmitted to the ADA House of Delegates
and to the American Dental Education Association."
Infectious Waste
State and government regulation
90:55-H-7
"Resolved, that the AGD recognize that state law and government regulation is
determining the definition and handling of infectious waste, and be it further
18
19
20
21
22
23
24
25
Resolved, that when evaluating the merit of such regulations, the AGD
primarily will be concerned about the safety of the public, and also will insist
that the
regulations be based on scientific validity with appropriate consideration given
to cost effectiveness."
26
27
Insurance, Malpractice
84:24-H-7
28
29
30
31
32
33
34
Legislation
Access to dental care
Incentives for dentists to practice in underserved areas
2001:29-H-8
35
36
37
38
"Resolved, that the Academy of General Dentistry continue to support the
American Dental Association's three-classification system for malpractice
insurance until such time as evidence has been presented to indicate that there is
merit in going to another system."
“Resolved, that the Academy of General Dentistry believes that in order to
encourage dentists to practice in underserved areas, the following must occur:
a.
The period over which student loans are forgiven must be extended to
10 years, without a tax liability for the amount forgiven in any year.
45
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Tax credits must be provided for establishing a dental practice in said
areas.
c.
Scholarships must be offered to dental students in exchange for
serving in said areas.
d.
Federal loan guarantees must be provided for the purchase of dental
equipment and materials.
e.
Appropriations for funding an increase in the number of dentists
serving in the National Health Service Corps must be enacted.
f.
Active recruitment of applicants for dental schools from underserved
areas.”
Legislative agenda for providing
2001:28-H-8
REVISED
HOD 7/2002
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
b.
“Resolved, that the Academy of General Dentistry believes that any effort
to get the necessary personnel to improve access to and utilization of dental
care for indigent populations will be multifactoral and complex, and
includes but is not limited to the following items (understanding that these
items are not prioritized and will vary from state to state):
a.
Take steps to facilitate effective compliance with governmentfunded dental care programs to achieve optimum oral health
outcomes for indigent populations.
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
raise fees to at least the 75th percentile of fees which
dentists currently charge
eliminate extraneous paperwork
simplify Medicaid rules
mandate prompt reimbursement
educate Medicaid officials regarding the unique nature of
dentistry
provide block grants to states from the federal government
for innovative programs
require mandatory annual dental examinations for children
entering school (analogous to immunizations) to determine
their oral health status
encourage education of patients in proper oral hygiene and
in the importance of keeping scheduled appointments
utilize case management to ensure that the patients are
brought to the dental office
46
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
x.
b.
increase general dentists’ understanding of the benefits of
treating the indigent
Establish Alternative Oral Health Care Delivery Service Units
i.
ii.
iii.
provide oral health care, education, and preventive
programs in schools
arrange for transportation to and from the centers
solicit volunteer participation from the private sector to staff
the centers
c.
Encourage private organizations such as Donated Dental Services,
fraternal organizations, and religious groups to establish and provide
service
d.
Provide Mobile and Portable Dental Units to service the
underserved and indigent of all age groups
e.
Identify educational resources for dentists on how to provide care to
pediatric and special needs patients and increase AGD dentist
participation
23
24
25
26
27
f.
Provide information to dentists and their staffs on cultural diversity
issues which will help them reduce or eliminate barriers to clear
communication and enhance understanding of treatment and
treatment options
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
g.
Pursue development of a comprehensive oral health education
component for public schools’ health curriculum in addition to
providing editorial and consultative services to publishers of primary
and secondary school textbooks
h.
Increase supply of dental assistants and dental hygienists
i.
Strengthen alliances with ADEA and other professional
organizations
j.
Expand the role that retired dentists can play in providing service to
the indigent.”
18
19
20
21
22
White Paper on Increasing Access to and Utilization of Oral Health Care
Services
47
1
2008:323-H-7
2
3
4
AGD opposes limiting political or PAC contributions
87:53-H-7
5
6
7
Community Health Centers
“Resolved, that the AGD recognizes that Community Health Centers can be a
component in the effort to increase access to oral health care if the Community
Health Center Board partners with local dental societies in order to contract with
locally practicing dentists and more adequately identifies and reaches
underserved and indigent (defined as 150% of the Federal Poverty Level)
populations, and be it further
Resolved, that appropriate legislative activity be pursued to ensure that
Community Health Centers are properly funded and function in the manner for
which they were intended.”
Deduction for member dues
87:55-H-7
21
22
23
“Resolved, that the Academy of General Dentistry support the use of the
cash method of accounting, and not the accrual method, where preferred, by
dentists engaged in the private practice of dentistry, and be it further
Resolved, that the Academy of General Dentistry communicate this position,
when necessary, to legislative and regulatory entities.”
2003:15A-H-7
14
15
16
17
18
19
20
"Resolved, that the Academy of General Dentistry opposes federal legislation
reducing limits on political action committee contributions to candidates for
elected office."
Cash method of accounting, not accrual
98:26-H-7
8
9
10
11
12
13
“Resolved, that the AGD adopt the White Paper on Increasing Access to and
Utilization of Oral Health Care Services.”
"Resolved, that the AGD support legislation and seek coalitions with other
professional organizations that will allow salaried professionals to fully deduct
dues to professional organizations without having to exceed the 2% of adjusted
gross income now required for deduction of miscellaneous tax deductions."
Dental Lab Disclosure
2008:320RS1-H-7
"Resolved, that the Academy of General Dentistry support legislation
that requires dental labs to provide written disclosure to dentists the place
of fabrication and the specific composition of all materials used in the
fabrication of dental restorations and appliances.”
48
1
2
3
Federal Trade Commission
88:51-H-7
4
5
6
"Resolved, that the Academy of General Dentistry has a high priority in urging
every member of Congress to join in the adoption of legislation that would
restrict the Federal Trade Commission from intervening in state-regulated
professions."
FTC's efforts to pre-empt state laws re corporate ownership
2008:309-H-7
“Resolved, that policy 86:31-H-7 be amended so that it reads:
"Resolved, that in the interest of safeguarding patient care and freedom of
choice, the AGD opposes any efforts by the Federal Trade Commission
and any other agencies to preempt state laws that prohibit non-dentist
owned corporate dental practices, and be it further
Resolved, that the AGD supports any efforts to challenge the Federal Trade
Commission's and any other agency's statutory authority to preempt state laws
regarding non-professional, non-provider ownership of health care practices."
7
8
9
General Practitioner's role as gatekeeper for oral health
2008:316-H-7
10
11
12
Government subsidized health care programs
78:21-H-6
13
14
15
16
17
18
19
20
21
22
23
24
25
“Resolved, that the AGD as an organization of general dentists make every effort
to inform policy makers of the potential effect increased specialization of dentists
will have on the fragmentation of dentistry, especially on rural communities’
access to oral health care.”
"Resolved, that AGD oppose all programs that allow government subsidized
health care delivery systems to compete unfairly with the private practice
delivery system, and be it further
Resolved, that the Legislative and Governmental Affairs Council direct their
efforts in concert with the appropriate councils of the ADA and their constituent
legislative councils to gather and disseminate all information which deals with
this issue to the appropriate leadership at the national and state levels, and be it
further
Resolved, that the leadership in the profession at national and state levels make
every effort to upgrade the information deficit of federal and state legislatures so
that they may be fully informed."
Guidelines for dealing with state legislation
89:54-H-7
"Resolved, that the Academy of General Dentistry use the following guidelines in
dealing with members requesting AGD action on legislation being proposed in
their state:
49
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
1.
Members have the right to know existing policies.
2.
The AGD will not intervene in the legislative affairs of a state or
province without the written request of the constituent AGD.
3.
Members requesting support from the AGD for a legislative position
will be asked to work through their constituent.
4.
Constituent secretaries/executive directors and Trustees will be
provided with copies of AGD correspondence with their members
regarding concerns about legislative issues being considered."
Indigent population, AGD as a voice for the
2008:310RS-H-7
“Resolved, that policy 2003:15B-H-7 be amended so that it reads:
“Resolved, that the AGD continue to be an advocate for the oral health of the
general population, including but not limited to the underserved.
16
17
18
Language interpretation at provider’s expense
2001:31-H-8
19
20
21
Legislative or regulatory mandates with inadequate scientific basis
2000:30-H-7
22
23
24
“Resolved, that the Academy of General Dentistry oppose any legislative or
regulatory mandate affecting the practice of dentistry which is based on
principles that do not have adequate scientific basis as determined by the AGD.”
Link between periodontal disease and low birth-weight babies
2003:14-H-7
25
26
27
“Resolved, that the Academy of General Dentistry is opposed to any federal, state
or local government mandate that would require a dentist or other health care
provider to supply, at the provider’s expense, language interpretation for patients
who do not speak English or who have limited proficiency with the English
language.”
“Resolved, that the Academy of General Dentistry supports legislation that
seeks to increase accurate and up-to-date professional and public awareness
of the link between periodontal disease in pregnant women and pre-term,
low-birth weight babies and the maternal transmission of caries.”
Managed care, AGD’s legislative priorities regarding
97:29-H-8
“Resolved, that the AGD’s legislative priorities with regard to dental managed
care encompass the following:
28
50
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
Patients will have the choice to select a plan with a point-of-service
option, with reasonable cost-sharing requirements in premiums and
per-service costs provided that those costs are not excessive.
Patients in a plan will be allowed to select their dentist, and change
that selection as the patient feels is necessary.
The plan shall provide access to an adequate mix and number of
dentists, including both general dentists and specialists, to ensure
access to those services covered by the plan C including patients in
rural and dentally under-served areas.
The plan shall allow patients with special needs to be referred to
appropriate providers including specialists.
The plan shall provide an appropriate appeals and grievance procedure
that allows for timely responses to patient and/or provider complaints.
The plan shall provide a dentist, licensed to practice in that state or
province where the services are provided, to be responsible for dental
treatment policies, protocols, and quality assurance activities.
The plan shall define and disclose limitations on coverage of
experimental treatments and provide timely written justification for
denial of such treatment to patients.
The plan shall not discriminate in participation, reimbursement, or
indemnification against any dentist solely on the basis of his/her
license.
The plan shall not prohibit or limit a dentist or other health
professional from engaging in communications regarding the patient’s
health status, health care, treatment options, or utilization review
requirements.
The plan shall not provide any financial incentives to dentists, other
health professionals, or reviewers to deny or limit care.
The plan shall provide dentists with reasonable notice of termination
and allow the dentist to appeal such a decision and take corrective
action if necessary.
51
1
2
3
4
5
The plan shall assume any liability resulting from the plan’s denying or
restricting treatment or referral to specialists.”
Mandating preferred provider organizations
84:25-H-7
6
7
8
Military dentists, special pay and incentives for
2001:30-H-8
9
10
11
12
13
14
15
National Practitioner Data Bank
“Resolved, that the Academy of General Dentistry supports the continued
existence and current structure and mission of the National Institute of
Dental and Craniofacial Research, and be it further
Resolved, that the AGD will take appropriate steps to lobby in support of
NIDCR.”
Nitrous oxide inhalation sedation
94:18-H-7
25
26
27
28
29
30
"Resolved, that the Academy of General Dentistry work with the ADA to urge
Congress and the Department of Health and Human Services to amend the
National Practitioner Data Bank so that it will include only information on
suspension of license, revocation of license or loss of hospital privileges for
disciplinary reasons.”
NIDCR
2003:18-H-7
19
20
21
22
23
24
“Resolved, that the Academy of General Dentistry request immediate action to
stem the exodus of current military dental officers and assure a continuing supply
of quality accessions, and be it further
Resolved, that the AGD favor increasing additional special pay, establishing
incentive pay for dentists, and increasing Health Professions Scholarship
Program (HPSP) scholarship funding.”
90:57-H-7
16
17
18
"Resolved, that the Academy of General Dentistry oppose any federal legislation
for the purpose of mandating preferred provider organizations, or pre-empting
state laws that regulate preferred provider organizations."
“Resolved, that the Academy of General Dentistry supports the use of scavenging
equipment for nitrous oxide, and be it further
Resolved, that any additional regulation of nitrous oxide be based on valid
scientific documentation.”
Prohibiting latex use without documented scientific evidence
98:22-H-7
“Resolved, that the Academy of General Dentistry be directed to oppose any
legislation or regulation that is not based on documented scientific evidence of
52
significant general risk to dental patients or workers which would prohibit the use
of latex or latex-containing products in the dental office.”
1
2
3
Protect dental insurance as a fringe benefit
81:24-H-7
4
2008:306-H-7
AMENDED 2008:306-H-7
“Resolved, that policy 81:24-H-7 be amended so that it reads:
"Resolved, that the AGD work to ensure that legislation would not adversely
affect an employer's decision to provide dental insurance.”
5
83:24-H-7
6
2008:307R-H-7
AMENDED 2008:307R-H-7
“Resolved, that policy 83:24-H-7 be amended so that it reads:
“Resolved, that the AGD resist efforts being made by third party dental benefits
programs to prohibit payment based on the specific technique used by the dentist
to render treatment for the patient.”
7
8
9
10
11
Public disclosure of information in National Practitioner Data Bank
2000:27-H-7
12
13
14
Public Health Service Surgeon General
96:55-H-7
15
16
17
18
19
20
21
22
23
“Resolved, that the AGD oppose public disclosure of National Practitioner Data
Bank information because it has the potential to provide misleading information
about physician and dentist competency.”
"Resolved, that the Academy of General Dentistry recommends and supports
continued and ongoing Congressional funding of the Office of the Surgeon
General of the United States Public Health Service in order to fulfill the mission of
administration and oversight of the Commissioned Corps of the USPHS,
and be it further
Resolved, that the AGD supports the appointment of the Surgeon General from
the ranks of the Commissioned Corps of the USPHS in keeping with existing
legislation that provides for this result."
Sales tax on professional services - AGD opposition
87:63-H-7
"Resolved, that the AGD recommend that its constituents work with ADA and
Canadian dental societies in opposing sales taxes on professional fees and
services."
53
1
2
3
State over federal regulation of the dental profession
82:30-H-7
4
5
6
Student Loan Interest Deduction
87:54-H-7
7
8
9
"Resolved, that the AGD support legislation seeking reinstatement of the full tax
deductibility of interest payments of student loans."
Tax credit in states with reimbursement rates below 75th percentile
2004:15-H-7
10
11
12
13
14
15
16
"Resolved, that the AGD supports the principle that in any regulation of the
dental profession the dental health interests of the public are better served by
the state rather than federal regulation."
"Resolved, that the Academy of General Dentistry seeks a tax credit not to
exceed $5000 for dentists participating in the Medicaid program in states where
reimbursement rates are less than the 75th percentile, and be it further
Resolved, that the credit be calculated on the difference between the state
Medicaid reimbursement rate and the most recent ADA Annual Fee Survey 75th
percentile schedule for the region."
Tobacco Cessation Treatment
2008:313-H-7
“Resolved, that treatment for tobacco cessation including appropriate
medication is within the scope of dental practice, and be it further
Resolved, that constituents be encouraged to lobby state and provincial
legislatures/dental boards where restrictions exist.”
17
18
19
Tobacco settlement earmarked for health care
2000:29-H-7
20
21
22
23
24
25
26
Resolved, that this position be communicated to constituent AGD presidents who
should work with state dental associations to see this is implemented in their
respective states.”
Water quality during routine dental treatments should be appropriate
2000:28-H-7
27
28
29
30
“Resolved, that the AGD support having monies from the settlement with the
tobacco industry be earmarked for health care and be it further
“Resolved, that the AGD supports the use of appropriate water quality during
routine dental treatments.”
Licensing
Limited to dentists and dental hygienists
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Licensure
By credentials
92:33-H-7
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"Resolved, that the Academy of General Dentistry encourage the American
Dental Association and the Canadian Dental Association to advocate a position
that will encourage the various states or provinces to allow graduates of dental
schools accredited by the Joint Commission on Accreditation of Dental Schools to
be licensed by credentials in other states or provinces by meeting these criteria
as a minimum:
1.
Having successfully passed the National Boards and
2.
Having passed a State or Provincial Board of Dental Examiners exam
and/or a regional licensure exam
3.
Having satisfactorily completed a jurisprudence and/or law exam if
required by that state or province and
4.
Having satisfactorily complied with the state or provincial law and
Principles of Ethics of the state or province in which the individual is
currently practicing."
"Resolved that the Academy of General Dentistry actively support licensure by
credentials by providing assistance to any region or constituent requesting
support in promoting the issue at the state level."
Malpractice Insurance and Litigation
Defending their capabilities to render dental procedures
81:12-H-7
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"Resolved, that there be no additional licensing of personnel in the dental
health field other than the dentist and the dental hygienist."
"Resolved, that members faced with problems of defending their capabilities to
render certain dental procedures be advised to seek help from local general
practitioners to serve as expert witnesses on their behalf, and be it further
Resolved, that the AGD assist individual members in need of credentials by
providing them with letters which may indicate any of the following points:
A.
The fact that the individual has been a member in good standing of the
AGD since a specific date.
B.
The number of hours of continuing education on record in the AGD's
central office for the member.
C.
Verification that the individual has achieved Fellowship or Mastership
status in the AGD.
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D.
Mandated Health Benefits
AGD policy on
87:51-H-7
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National Practitioner Data Bank
AGD efforts to control regulations relating to infectious waste control
"Resolved, that the AGD work with the ADA in negotiating with OSHA and other
governmental agencies to make regulations involving infection control, hazard
communication and infectious waste less onerous and more economical for the
general public and the dental profession."
AGD influence in adopting guidelines
89:52-H-7
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"Resolved, that the Academy of General Dentistry recommends limiting access to
the National Practitioner Data Bank to those persons and entities originally
authorized to report to and query the data bank by the Health Care Quality
Improvement Act of 1986."
OSHA
89:57-H-7
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"Resolved, that the Academy of General Dentistry opposes federal and state laws
mandating health and related benefits because such laws may increase health
care costs, reduce employers' incentives to hire full-time staff members, increase
a trend toward underemployment of auxiliaries, and reduce incentives for
employers to provide health care benefits since such laws place solo and small
group practitioners at an economic disadvantage, and be it further
Resolved, that Congress and the states should explore alternatives to
government-mandated benefits, including favorable tax incentives that
encourage employer expansion of health care and related benefits."
94:17-H-7
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Any of the individual's activities as a member, including the
committees he has served on and the offices he has held in the AGD."
"Resolved, that the Academy of General Dentistry work to influence the
formation of OSHA guidelines that would protect the privacy and quality of
patient care during the time of office inspection, and be it further
Resolved, that the Academy of General Dentistry request the ADA to include
the following points in its negotiations with OSHA:
1.
Inspectors should allow normal office operation to continue during
inspection.
2.
Inspectors should not interfere with patient care.
3.
Inspectors should not attempt to speak with a dentist who is engaged
in direct patient care or consultation with a patient.
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“Resolved, that the AGD support the ADA’s position on OSHA’s anticipated
proposed rule on Workplace Safety & Health Programs as outlined in the letter
written by Dr. William S. TenPas and attached to this report as Addendum A.
"Resolved, that the Academy of General Dentistry work in conjunction with the
American Dental Association to oppose any OSHA worker safety regulations that
are not substantiated by scientific documentation."
Patient Records
Confidentiality of
"Resolved, that the Academy of General Dentistry support the principle of
maintaining the confidentiality of patients' dental records, and be it further
Resolved, that the Academy of General Dentistry considers the compulsory
in-office audit of dental offices to be an invasion into the confidentiality of
patients' dental records."
Pediatric Dentistry
Defined
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Inspectors should not make comments to a dentist, staff or other
inspectors within patients' hearing."
Worker safety regulation, opposition
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5.
The AGD specifically supports an exemption in any final OSHA regulation on
Workplace Safety & Health Programs for both small employers and low risk
employers.”
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Inspectors should not invade or in any way compromise a patient's
privacy or confidentiality.
AGD supports the ADA’s position on OSHA’s anticipated rule on Workplace Safety & Health
Programs
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4.
"Resolved, that the Academy of General Dentistry supports the adoption of the
following revised definition of the specialty of pediatric dentistry:
'Pediatric dentistry is an age-defined specialty that provides primary,
comprehensive, preventive and therapeutic oral health care for infants and
children through adolescence, and may also include the treatment of those
with special health care needs.'"
Peer Review Committees
For general dentists
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Resolved, that the AGD vigorously oppose the formation of lists of dental
services which might indicate that a general dentist is not qualified to perform
certain procedures."
Quality control review by
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"Resolved, that the AGD endorses quality control review in the United States only
by peer review committees established by ADA constituents and rejects the
concept that quality review is the prerogative of prepayment programs."
Post Graduate Training
Availability for all recent graduates
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"Resolved, that the peer review mechanisms of organized dentistry be the sole
factor in determining whether a dentist is qualified to perform a particular dental
service, and be it further
"Resolved that the Academy of General Dentistry support, with the American
Dental Education Association, the development of one-year postgraduate training
programs accessible to all dental school graduates, and be it further
Resolved, that the program(s) incorporate the following concepts:
a)
that the program should be in the category of post-graduate education
with an appropriate stipend, and should not be a fifth year of dental
school with potential for increased student indebtedness.
b)
that the program should prepare a dentist for private practice,
incorporating both clinical skill enhancement and practice
management training.
c)
that the Commission on Dental Accreditation should develop and
implement appropriate standards and criteria for such one-year
postgraduate training program, including the definition of credentials
required of program directors.
d)
that program(s) be developed with sufficient flexibility for operation in
the offices of selected practitioners, indigent care centers or public
health sites.
e)
that participants in post graduate training at public health sites be
eligible for debt repayment programs, and be it further
Resolved that the AGD's position be communicated in writing to both the
ADA's Commission on Dental Accreditation and to the American Dental
Education Association."
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Public Information
Monitoring dental health messages to the public
98:20-H-7
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Radiographs
Dental assistants must be properly trained to use
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“Resolved, that AGD monitor dental health messages communicated to the public
in an effort to see that the interest of the general dentist is properly reflected.”
"Resolved, that AGD recognizes that dental assistants should be properly trained
to safely utilize radiological equipment, and be it further
Resolved, that AGD recognizes the need to have dental radiological equipment
appropriately monitored in order to ensure the safety of the public, and be it
further
Resolved, that AGD encourages the ADA to establish a comprehensive
radiological safety program."
Submission to insurance carriers
2006:22R-H-7
“The AGD endorses the most current radiographic recommendations developed
by the Food and Drug Administration once reviewed by the appropriate AGD
agency which will serve as a guide to the general dentist’s professional judgment
of how to best use diagnostic imaging tools for each patient, and be it further
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Salaried Dentists
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Resolved, that the AGD support legislative proposals that promote an increase
in remuneration for dentists serving in the government to a level that is
competitive with dentists in the civilian sector."
Sedation
Adequate facilities for teaching
87:57-H-7
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"Resolved, that the AGD strongly support governmental dentists being
remunerated at a level competitive with dental incomes in the civilian sector, and
be it further
"Resolved, that the Academy of General Dentistry use the following definition to
define adequate facilities for the teaching of conscious sedation at the
undergraduate and continuing dental education levels:
'An area equipped with suction, monitoring equipment, emergency drugs, and
equipment to deliver oxygen under positive pressure in relatively quiet and
private surroundings.'"
Teaching of, at the undergraduate and CE levels
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86:36-H-7
AMENDED HOD 2008
2008:204-H-7
“Resolved, that the following resolution be amended to read:
2
“Resolved that policy 86:36-H-7 be amended so that it reads:
"Resolved, that the Academy of General Dentistry supports the teaching of
conscious sedation at the undergraduate and continuing education levels in
dental schools and other adequate teaching facilities as defined by the
AGD's Education Council.”
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Smoking
AGD position on use of Tobacco
90:41-H-7
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"Resolved, that the Academy of General Dentistry believes that the use of
tobacco has a significantly adverse impact on the public's oral and general health
and encourages its members and all general practice dentists and members of
the dental health team to promote tobacco abstinence through patient
education; and be it further
Resolved, that the AGD encourages all dental offices to serve as model
tobacco-free environments and to work actively within the community to
promote tobacco abstinence and to educate school-age children on the
hazards of tobacco use."
Specialty License Laws
73:20-H-10
"Resolved, that the Academy of General Dentistry continue to oppose the
creation of specialty licensure laws within various states and that state
Academies should remain vigilant against further expansion of these programs."
74:11-H-11
"Resolved, that the Academy of General Dentistry express its strong opposition to
development of specialty license laws as part of state dental practice acts and
that the AGD continue to support the position of the American Dental
Association."
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Specialty Listings
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"Resolved, that the Academy of General Dentistry urge its members to oppose
specialty listings whenever proposed because of the adverse effect such a policy
has on selection by the public of a general dentist as the primary vehicle of entry
into the dental care delivery system."
State Board of Dentistry
94:16-H-7
"Resolved, that in the interest of the dental health of the public, the Academy of
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General Dentistry support maintaining the dental licensing authority at the State
Board level, and be it further
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Resolved, that the Academy of General Dentistry support a single State
Board(s) of Dentistry in each state, as the sole regulating authority(ies) for
entry level licensure of dentists and hygienists, and be it further
Resolved, that the AGD support state board examinations for entry level
licensure, and be it further
Resolved that the following resolution be sent to the ADA's 1985 House of
Delegates:
'Resolved, that the American Dental Association, in the interest of the
dental health of the public, supports a single State Board of Dentistry in
each state, as the sole regulating authority for the delivery of dental
care'
and be it further
Resolved, that the following resolution be sent to the ADA's 1994 House of
Delegates:
'Resolved that the American Dental Association, in the interest of the
dental health of the public, support maintaining the dental licensing
authority at the State level and be it further
Resolved, that the American Dental Association support a single State Board of
Dentistry in each state, as the sole regulating authority for entry level licensure
of dentists and hygienists', and be it further
Resolved that the ADA support state board examination for entry level
licensure."
Sterilization
Procedures
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"Resolved, that the Academy of General Dentistry believes the public good is best
served by sterilization procedures for the dental office that provide patients with
maximum protection against any possibility of cross contamination and that
demonstrate the dentist's commitment to patient health and safety, and be it
further
Resolved, that the AGD reaffirms its policy of sterilization by currently accepted
methods, including heat sterilization of dental instruments between every
patient, and be it further
Resolved, that the Academy of General Dentistry work with the American
Dental Association, the Canadian Dental Association, the National Dental
Association, and the Centers for Disease Control to encourage all dentists to
follow this policy and to raise public awareness of the safety of the dental
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office and the measures that ensure health and safety of the public and of all
involved in dental care delivery."
Surveys
Of dental schools, annually
94:23-H-7
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"Resolved, that the annual survey of dental schools to investigate the progress
toward an academic postgraduate degree or other recognition for the general
practitioner be discontinued as it is no longer effective in evaluating the activities
of dental schools with regard to the training of general dentists."
Table of Allowances
Acceptable reimbursement mechanism
76:52-H-11
"Resolved, that the Academy of General Dentistry go on record as endorsing the
table of allowances as an acceptable reimbursement mechanism."
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Public Affairs
Guidelines
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Advocacy Guidelines
ACADEMY OF GENERAL DENTISTRY
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Announcement of Credentials to The Public: A Position Paper
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EXECUTIVE SUMMARY
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The purpose of the “Credential and Dental Marketing: A Position Paper”
(Position Paper) is to set forth to dental regulating bodies of each state (i.e.,
state dental boards), the reasons that the Academy of General Dentistry (AGD)
believes that general dentists should be permitted to advertise credentials
earned by meeting rigorous requirements imposed by professional
organizations whose educational programs may not be subject to a formal
accreditation process.
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Professional organizations, as discussed herein and in the Position Paper, are
limited to those that award credentials for dentists who have met rigorous
requirements in continuing education through targeted PACE or CERP approved
coursework, comprehensive examinations, and longevity in dental practice as
verified by sustained organizational membership.
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Professional credentials awarded by these professional organizations recognize
the achievement of proficiency in areas of dentistry outside the nine specialties
identified by the American Dental Association (ADA).
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Proficiency is “the level of knowledge, skills, and values attained when a
particular activity is accomplished in more complex situations, with repeated
quality, and with a more efficient utilization of time,”2 and signifies a higher
standard than competency.
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Patient care and protection is the ultimate goal of the AGD, and public
awareness of dentists’ proficiencies through advertising of credentials earned
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by meeting rigorous requirements imposed by professional organizations shall
assist patients in selecting the appropriate dentists for their specific needs,
while restrictions to advertising of these credentials may falsely depreciate
their value to the public and may obstruct the patients’ ability to make
independent, unbiased and fully informed health care decisions.
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The sole purpose of this Position Paper is to set forth before state dental
regulating bodies (i.e., state dental boards), the AGD position provided herein
on credential and dental marketing.
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2
Commission on Dental Accreditation (CODA), Accreditation Standards for
Advanced Education Programs in General Dentistry, 1998. Cited section
excerpted from definition provided for “Proficient.”
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Coordination of Benefits Guidelines
1.
When a patient has coverage under two or more dental plans, the coverage from
those plans should be coordinated so that the patient receives the maximum allowable
benefit from each plan. The aggregate benefit should be more than that offered by
any of the plans individually, but not such that the patient receives more than the total
charges for the dental services received.
2.
In determining order of payment for benefits, the following rules should apply:
3.
4.
a.
The plan covering the patient other than as a dependent is the primary plan.
b.
When both plans cover the patient as a dependent child, the plan of the
parent whose birthday occurs first in a calendar year should be considered as
primary.
c.
When a determination cannot be made in accordance with the above, the plan
that has covered the patient for the longer time should be considered primary.
d.
When one of the plans is a medical plan and the other is a dental plan, and a
determination cannot be made in accordance with the above, the medical plan
should be considered as primary.
In coordinating benefits with a dental plan which contractually reduces the fees for
services which participating dentists accept as payment in full, the following rules
should apply:
a.
When the reduced-fee plan is primary and treatment is provided by a
participating dentist, the reduced fee is that dentist's full fee. The secondary
plan should pay the lesser of: its allowed benefit or the difference between
the primary plan's benefit and the reduced fee.
b.
When the reduced-fee plan is primary and treatment is provided by a
non-participating dentist, the reduced fee plan should provide its allowed
amount for non-participating dentists and the secondary plan should pay the
lesser of: its allowed benefit for the service or the difference between the
primary plan benefits and the dentist's full fee.
c.
When a full-fee plan is primary and a reduced-fee plan is secondary, the
full-fee plan should provide its allowed amount for the service and the
secondary plan should pay the lesser of: its allowed benefit for the service or
the difference between the primary plan benefits and the dentist's full fee.
In coordinating benefits between an indemnity and a capitation dental plan, the
following rules should apply:
a.
When the capitation plan is primary, the capitation payments to the treating
dentist remain the capitation plan's usual benefits. The indemnity plan should
pay benefits for the patient's surcharges or copayments up to the indemnity
plan's allowable benefit.
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b.
When the indemnity plan is primary, and treatment is received from a
capitation-participating doctor, the indemnity plan should pay its allowable
benefits. The capitation payments to the dentist are the secondary coverage
since they constitute benefits up to the capitation plan's allowable amount.
c.
When the indemnity plan is primary, and treatment is received from a
non-capitation-participating dentist, the indemnity plan should pay its
allowable benefits. The capitation plan will pay benefits, in keeping with the
capitation plan's allowed amount for treatment by non-participating dentists.
d.
No dental plan should contractually direct a dentist to charge a secondary
carrier for more than the amount which would be charged to the patient
absent secondary coverage.
5.
Third-party payers, representing self-funded as well as insured plans, should be urged
to adopt the above guidelines as an industry-wide standard for coordination of
benefits.
6.
Constituent societies are encouraged to seek enactment of legislation that would
require all policies and contracts that provide benefits for dental care to use these
rules to determine coordination of benefits.
And be it further
Resolved, that third-party payers, representing self-funded as well as insured plans, should be
urged to adopt these guidelines as an industry-wide standard for coordination of benefits, and
be it further
Resolved, that constituent societies are encouraged to seek enactment of legislation that
would require all policies and contracts that provide benefits for dental care to use these rules
to determine coordination of benefits.'"
Adopted HOD 7/93
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Dental Care Policy Guidelines
The Academy of General Dentistry notes an increased interest by the general public on all levels in
dental care programs both private and government sponsored. In keeping with the general outlook
and purposes of the Academy, it is necessary to promulgate certain policy guidelines which will assist
the profession and allied agencies involved in the maintenance and improvement of high quality
dental care.
The objectives and purposes are:
1.
To promote the science and art of dentistry and the betterment of the public health,
encourage oral research, and to preserve the rights and freedom of the dentist and the
patient.
2.
To preserve the right of the general practitioner to engage in dental procedures for which
he/she is qualified by training and experience.
3.
To provide and guide continuing education programs and study group activity for general
practitioners and to encourage and assist practicing dentists to participate in such program
toward continuing education competence.
4.
To provide effective representation for the general practitioner in all matters of interest to the
profession and the public it serves.
5.
To maintain an active organization of general practitioners of dentistry.
6.
To motivate and assist young men and women in preparing, qualifying and establishing
themselves in the general practice of dentistry.
7.
To promote uniform methods of reporting treatment contemplated and rendered.
8.
To affirm that the prime responsibility of total dental health care rests with the general
practitioner.
In fulfilling these goals, the Academy supports the following principles as its policy on dental care
programs:
1.
Any government dental health program which has as its principal requirements that:
a.
All drinking waters be fluoridated as needed.
b.
Concepts and programs of preventive dentistry be taught and implemented for
children in schools, and a program for adult preventive care be instituted both in the
dental office and community service clinics.
c.
A massive effort be undertaken to discover the cause and cure of dental disease.
2.
The right of the general practitioner to practice all phases of dentistry must be preserved in
every state.
3.
The doctor-patient relationship must be maintained without interference by a fiscal
intermediary.
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4.
The Academy supports a prepayment evaluation mechanism that establishes a working liaison
with insurance carriers and other fiscal agents for the review of prepayment programs. The
Academy supports only those prepaid dental programs which meet the standards of the
American Dental Association, or its equivalent. The Academy is opposed to any program which
denies the right of the dentist to preform any services for which he/she is licensed and
qualified to perform or one which limits the patient in his/her freedom of choice of a dentist.
5.
Wherever and whenever the Academy finds discrimination in third party programs involving
the general practitioner and/or patients, it will make every effort to correct the problem.
Failing to do so, the Academy will then seek relief through the American Dental Association or
its equivalent or through appropriate legal channels.
6.
Legislative contracts should be established and maintained from the individual member up
through the state and national levels to assist general practitioners and the community in
programs involving health legislation.
7.
Every constituent of the Academy shall have an active dental care committee which will report
on an annual basis to the AGD National Dental Care Committee for proper coordination and
development of programs on a nationwide basis.
8.
The Academy supports a pluralistic system of dental prepayment including private insurance
carriers, service corporations, private payment by patients and limited government payment.
9.
The AGD endorses and supports co-insurance in addition to those programs offering total or
paid in full coverage.
10.
An acceptable fee for any dental care service is that amount which is mutually agreeable to
both the patient and the dentist, based on all factors involved in the treatment. Any fee
established by a third party (for example, that called usual and customary) is to be regarded as
an indemnification toward the fee agreed by the dentist and the patient.
11.
The plan must not involve the dentist as a contractual party nor shall the plan publish a list of
participating dentists.
12.
The Academy supports the view that the public has the right to have access to comprehensive
dental care. However, the Academy opposes any government health program which would
use public funds to provide dental care for persons who are financially able to pay for dental
services. Current medicaid programs should be expanded to include more comprehensive
dental care.
13.
The Academy should be represented in all agencies of the American Dental Association or its
equivalent which deal with dental care programs. The Academy wishes to cooperate in every
possible effort not only on behalf of the general practitioner, but also on behalf of the total
profession and the public.
14.
The American Dental Association should be encouraged to review dental insurers' plans to
make certain the coverage provided is presented accurately to the patient.
Adopted GA 2/72
Revised HOD 11/74
Amended HOD 7/77
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Educational Objectives for the Provision of Dental Implant Therapy by Dentists
INTRODUCTION
In February 2009, the Academy of General Dentistry (AGD) created an Implantology Task
Force (ITF) comprised of nine general practitioners with substantial dental implant
experience.
The purpose of the ITF was to review the current state of dental implant training in the United
States and formulate guidelines. These guidelines would delineate the objectives that are
recommended in coursework for educating dentists about safe and appropriate dental implant
therapy.
Various dental implant reference materials were reviewed, and pertinent information gleaned
from these sources aided in the construction of this document.
Additionally, the observations and experiences of the members of the ITF, many of whom are
educators in implant dentistry, were used to develop these training objectives.
It is not the purpose of these Educational Objectives to define a curriculum for dental implant
therapy. Rather, these objectives are to be used as guidelines for educational providers to
develop curricula that will adequately prepare dentists for providing safe and appropriate
dental implant therapy.
There are a variety of educational outlets available to provide dentists with the necessary
training in dental implant therapy. These outlets include, but are not limited to, universitybased sources, hospital-based sources, dental organizations, manufacturer-sponsored courses,
private individuals, and commercial training centers.
All providers of dental implant continuing education (CE) should be AGD PACE- or
American Dental Association (ADA) CERP-approved.
Dental implant therapy can be accomplished successfully by all licensed dentists who have
received adequate training. No manufacturer, university, hospital, or provider of CE should
limit any licensed dentist from having access to the specific knowledge base or materials
needed to provide quality care through the provision of dental implant therapy.
As a “prosthetic discipline with a surgical component,” the placement of dental implants is
part of the practice of general dentists and specialists alike who have attained the appropriate
education.1
Dentists performing the surgical placement of dental implants should have an understanding
of the final prosthetic goal of each case and the various elements of the restorative process.
Dental implants provide support for restorations that substitute for missing dentition. Dental
implant therapy restores the patient’s function, form, and esthetics, as well as comfort and
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longevity, and has become the tooth replacement methodology of choice for many patients.
Additionally, dental implant therapy facilitates the health and preservation of the remaining
oral structures.
In anticipation of untoward circumstances that may occur during the treatment process or after
the restorative phase has been completed, dentists should have attained the education
necessary to be familiar with interventions needed to manage those circumstances.
GLOSSARY
Autogenous graft
Hard or soft tissue harvested from one or more sites and transplanted to another site or other sites in
the same individual.2
CERP
“Recognizing the need to offer its members and the dental community a way to select continuing
education (CE) with confidence, to assist regulatory agencies and other organizations responsible for
approving credit, and to promote the continuous improvement of CE, the American Dental
Association Continuing Education Recognition Program (ADA CERP) was established in 1993. Through
an application and review process, the ADA CERP evaluates and recognizes institutions and
organizations that provide continuing education (CE).”3
Dental implant
A dental implant is an alloplastic material or device that is surgically placed into or onto orofacial
tissues and used for anchorage, functional, therapeutic, and/or esthetic purposes.2
Dental implant prosthesis
Syn: Dental implant restoration. “Any prosthesis (fixed, removable, or maxillofacial) that utilizes
dental implants in part or whole for retention, support, and stability.”2
Dental implant therapy
Syn: Implant dentistry, oral implantology. The field of dentistry dealing with the diagnosis, surgical
placement, prosthetic reconstruction, and maintenance of dental implants.2
Exogenous graft
Hard or soft tissue derived from outside the patient’s body.2
Familiarity
“A simplified knowledge for the purposes of orientation and recognition of general principles.”4
PACE
“The Academy of General Dentistry (AGD) Program Approval for Continuing Education (PACE) was
created to assist members of the AGD and the dental profession in identifying and participating in
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quality continuing dental education (CDE). The program provider approval mechanism is an
evaluation of the educational processes used in designing, planning, and implementing continuing
education.”5
DENTAL IMPLANT VARIATIONS
Dentists involved in the practice of implant dentistry should have a familiarity with the
various dental implants and dental implant restorations that are presently available, even
though the dentists may be placing and/or restoring only one brand or modality.
This familiarity may aid in the recognition of a dental implant device either clinically or
radiographically and allow for maintenance protocols. Additionally, familiarity with the
various dental implants and dental implant restorations will aid the dentist in exercising his or
her professional judgment to treat the patient or make an appropriate referral.
DENTAL IMPLANT CASE TYPES6
Current literature indicates that surgery may be divided into two case types: straightforward
and complex.
The type of case is not an absolute measure. After completion of adequate coursework in
dental implant therapy, the dentist should be able to assess the case type and make treatment
or referral decisions accordingly.
Dental implant therapy, regardless of case type, may be performed safely by an appropriately
trained dentist, and these case types are not determinative of need for referral.7
The following attributes of straightforward and complex cases are indicative but not
singularly determinative of the respective case types, and are presented below by
interpretation of and/or citation of current literature:6
Straightforward case:
Perception of Case: The end prosthetic result and treatment protocols are readily understood.
Tooth Position: Adequate identifiable anatomical landmarks exist to determine optimal tooth
position.
Dental Implant Surgery: The dental implant surgery procedure has minimal anatomical risks and can
be carried out without the need for significant hard or soft tissue grafting.
Occlusion: The teeth can be replaced without significant alteration to the patient’s existing anatomic
structures.
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Complex case:
Perception of Case: The end prosthetic result and treatment protocols cannot be readily
determined without extensive diagnostic and planning techniques and may include multiple
stages to achieve the desired outcome.
Tooth Position: Minimal identifiable anatomical landmarks require more extensive diagnostic
procedures to determine the optimal tooth position for esthetics and function.
Dental Implant Surgery: The dental implant surgery is a more challenging procedure with notable
anatomical risks and may require significant hard or soft tissue grafting.
Occlusion: A deterioration of the patient’s anatomic structures requires significant treatment
planning to adequately restore the occlusion.
EDUCATIONAL OBJECTIVES
Educational objectives for the straightforward placement of dental implants:
A dentist who intends to engage in the straightforward placement of dental implants should have
attained education that includes the educational objectives listed below. The dentist should be
familiar with the procedures involved in the assessment, planning, placement, restoration, and
maintenance of dental implants.6
1. Anatomy of the maxilla and mandible.
2. Pathological processes that occur in the maxilla and mandible.
3. Healing processes that occur following surgery and how to manage postoperative untoward
circumstances.
4. Diagnostic imaging of the mandible and maxilla, and how to interpret the findings from these
examinations.
5. Clinical assessment of a patient’s suitability for dental implants and the medical conditions
that could preclude a patient from dental implant therapy or complicate surgery.
6. Infection control and aseptic techniques as applied to dental implant surgery.
7. Techniques involved in harvesting autogenous bone from oral sites for augmentation during
dental implant placement.
8. The use of exogenous bone, bone substitutes, and/or soft tissue for augmentation in the
placement of dental implants.
9. The use of appropriate pharmaceutical agents in relation to implant dentistry.
10. The dental implant options available and their indications and contraindications.
11. Patient informed consent and how to obtain it prior to dental implant placement.
12. Clinical and laboratory protocols for dental implant therapy, including:
a. An understanding of the clinical techniques for conventional dental implant
restorative procedures.
b. An understanding of the pre-surgical laboratory procedures and techniques used to
provide dental implant therapy.
c. An understanding of the laboratory techniques used to construct implant-supported
prostheses.
d. An understanding of the clinical restorative procedures involved in straightforward
dental implant-supported restorations.
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e. A recognition of technical and cosmetic limitations of implant dentistry.
13. Long-term maintenance of dental implants and dental implant restorations.
14. Proper documentation of all clinical activity.6
15. Assessment of the occlusion and its relevance in relation to the proposed treatment and
longevity of the prosthesis.8
16. Interventions and approaches to manage potential complications.
Additional guidelines for complex dental implant therapy:6
Experience in the straightforward placement and/or restoration is a prerequisite for complex dental
implant therapy.
A dentist should have attained an adequate level of surgical experience and the ability to provide
follow-up care to patients who require the placement of dental implants with hard and soft tissue
augmentation.
Before complex placement is attempted, a dentist also should have attained the knowledge of the
prosthetics necessary for the substantial occlusal alterations that are often needed in restoring and
maintaining complex cases.
As dentists advance through the developmental stages of skill acquisition, it would be advantageous
for them to seek the assistance and guidance of more experienced dentists to serve as mentors.
DISCLAIMERS
Dental implant therapy may be performed safely by an appropriately trained dentist. These
Educational Objectives are not intended to limit the training or practice of dentists in dental implant
therapy, nor are they intended to make any representations regarding the qualifications or abilities
of any individual dentist or dental specialty.
The AGD expressly disclaims any and all liability arising out of or in any way related to the use,
transmission, reliance, or interpretation of these Educational Objectives or any part thereof.
REFERENCES
1. Zablotsky M. The periodontal approach to implant dentistry. J Calif Dent Assoc 1991
December;19(12):39-43.
2. Jalbout Z, Tabourian G, eds. Glossary of implant dentistry II. Upper Montclair, NJ: The
International Congress of Oral Implantologists (ICOI):2008.
3. ADA Continuing education recognition program (ADA CERP). Available at:
www.ada.org/prof/ed/ce/cerp/index.asp. Revised April 2008.
4. American Academy of Implant Dentistry. Standards for the advanced education
programs in implant dentistry. Revised February 2007.
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5. AGD PACE Guidelines. Available at: www.agd.org/files/education/pace/guidelines.pdf.
Revised January 2009.
6. Faculty of General Dental Practice (UK), The Royal College of Surgeons of England.
Training standards in implant dentistry for general dental practitioners. Available at:
www.fgdp.org.uk/pdf/training_stds_imp_dent_guide_2008.pdf. Accessed November 2008.
7. Academy of General Dentistry. General guidelines for referring dental patients to
specialists and other settings for care. Revised July 2007.
8. Academy of Osseointegration; Committee for the Development of Dental Implant
Guidelines; American Academy of Periodontology, Iacono VJ, Cochran SE, Eckert MR,
Wheeler SL. Guidelines for the provision of dental implants. Int J Oral Maxillofac Implants
2008 May-Jun;23(3):471-473.
The AAID’s Guidelines for MaxiCourses® (2008) also served as a resource for this document.
Respectfully submitted by:
John P. DiPonziano, DDS, MAGD (Chair)
Russell A. Baer, DDS
Walter C. Chitwood, Jr., DDS
Richard W. Dycus, DDS, MAGD
Leonard R. Machi, DDS, FAGD
Emile Martin, DDS, MAGD
Richard J. Ringrose, DDS, MAGD
Berry Stahl, DMD
Roger D. Winland, DDS, MS, MAGD
Staff Support:
Daniel Buksa, JD, Associate Executive Director, Public Affairs
Srini Varadarajan, Esq., Director, Dental Care Advocacy
Adopted HOD 7/09
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POLICY STATEMENT ON TREATMENT OF MEDICALLY COMPROMISED DENTAL PATIENTS
With the aging of the population and the spread of infectious diseases, dentists will encounter
growing numbers of medically compromised patients, including those with infectious diseases.
The general dentist, as primary dental care provider, plays the key role in providing and
coordinating dental care for such patients. In this role dentists have responsibilities to all
patients, staff and other parties which they are ethically bound to fulfill.
Responsibilities to the Medically Compromised Patient
o
To treat the patient with kindness and compassion, regardless of the nature of the
patient's condition.
o
To be sufficiently educated to evaluate the dental health of a medically compromised
patient and to consult with physicians, when necessary, regarding the patient's
medical status.
o
To provide appropriate treatment within the dentist's realm of competence.
Responsibilities to Dental Staff
o
To ensure that staff are trained in emergency care, the management of special health
conditions and the management of medically compromised patients.
o
To advise staff of the health status of each patient so they may employ appropriate
procedures and avoid procedures that may place themselves or the patient at
unnecessary risk.
o
To ensure that all staff members are properly educated so they understand that
infection control measures, including barrier techniques are in place and practiced
routinely to protect them against disease. With this understanding they can properly
render compassionate care to a medically compromised patient.
Responsibility to Other Parties
o
Dentists must observe state and/or federal laws and regulations that require providers
to protect the confidentiality of the patient.
Ethical Considerations for Treating HIV Positive Patients
The Academy believes that dentists are obligated to observe the American Dental Association's
Principles of Ethics and Code of Professional Conduct in the treatment of all patients including
those who are medically compromised, of which HIV positive patients are a part."
Adopted HOD 7/92
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Academy of General Dentistry
White Paper on Enteral Conscious Sedation
Enteral Conscious Sedation White Paper
I. Introduction
A. AGD Policy Statement on the Use of Enteral Conscious Sedation in Dentistry
B. AGD Statement of Purpose
In recognizing the importance of controlling anxiety and pain in dental patients, the AGD
believes all dentists should have adequate access to training in enteral conscious sedation
and the availability to practice this modality.
Training may be received through pre- or post-doctoral education or in a continuing
education program.
II. Definitions
Sedation: A depressed level of consciousness. Because sedation incorporates a continuum of
central nervous system (CNS) depression, specific levels are defined:
Anxiolysis (minimal sedation): The diminution or elimination of anxiety. This may be
accomplished by the use of medication that is administered in an amount consistent
with the manufacturer’s current recommended dosage and/or judgment on the part
of the clinician with or without nitrous oxide and oxygen.
When the intent is anxiolysis only, the definition of enteral conscious sedation and
the training and performance standards described herein do not apply.
Conscious Sedation (moderate sedation): A minimally depressed level of
consciousness that retains the patient’s ability to independently and continuously
maintain an airway and respond appropriately to physical stimulation or verbal
command and that is produced by a pharmacological or non-pharmacological
method or a combination thereof.
In accord with this particular definition, the drugs and/or techniques used should
carry a margin of safety wide enough to render unintended loss of consciousness
unlikely. Further, patients whose only response is reflex withdrawal from repeated
painful stimuli would not be considered to be in a state of conscious sedation.i
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Enteral Conscious Sedation: Any technique of conscious sedation in which the
sedative agent is absorbed through the gastrointestinal (GI) tract or oral mucosa
(e.g., oral, rectal, or sublingual).
Deep Sedation: An induced state of depressed consciousness accompanied by partial
loss of protective reflexes, including the inability to continually maintain an airway
independently and/or to respond purposefully to physical stimulation or verbal
command, and is produced by a pharmacological or non-pharmacological method or
combination thereof.ii
Patient management at this level of sedation is beyond the scope of this document
and mandates advanced formal training in general anesthesia.
Maximum Recommended Dose (MRD): Maximum recommended single dose of a
medication that can be prescribed for a particular indication.
American Society of Anesthesiologists (ASA) Physical Status Classification Systemiii:
ASA Physical Status
Classification
ASA Definition
AGD Recommendations
pertaining to sedation
I
A normal healthy patient
Normal sedation protocol
II
A patient with a mild systemic
disease
Normal sedation protocol is
generally indicated with
consideration for
modification of sedation
protocol
III
A patient with severe systemic
disease
Normal sedation protocol
may be indicated after
serious consideration for
modification of sedation
protocol
IV
A patient with severe disease
that is a constant threat to life
Invasive dental care (elective
or emergency) is not
indicated in the dental office
setting
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ASA Physical Status
Classification
ASA Definition
AGD Recommendations
pertaining to sedation
V
A moribund patient who is not
expected to survive without
the operation
Not Applicable
VI
A declared brain-dead patient
whose organs are being
removed for donor purposes
Not Applicable
Treatment Modifications per ASA Physical Classification System:
Modification of sedation protocol for medical risk patient (ASA II,
III)iv
• Recognize the patient’s degree of medical risk.
• Complete medical consultation before dental therapy, as needed.
• Schedule the patient’s appointment at a time of day when their stress
will be least.
• Monitor and record preoperative and postoperative vital signs.
• Use sedation regimen with minimal potential for causing physiologic
disturbances.
• Administer adequate pain control during therapy.
• Ensure length of appointment does not exceed the patient’s limits of
tolerance.
• Follow up with postoperative pain and anxiety control.
• Telephone the higher medical risk patient later on the same day that
treatment was delivered.
• Arrange the appointment for the highly anxious or fearful, moderateto-high-risk patient during the first few days of the week when the
office is open for emergency care and the treating doctor is available.
III. Training Requirements
A. General Guidelines
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1. All persons involved in the management of sedation patients must hold a currently
valid Basic Life Support (BLS or CPR) for Healthcare Providers card.
2. An adult enteral sedation course shall consist of a minimum of twenty hours of
didactic training that meets the requirements of the ADA's "Guidelines for Teaching
the Comprehensive Control of Anxiety and Pain in Dentistry" and has twenty
sedation experiences. This training may consist of videotaped cases of actual
sedations, which may be edited to emphasize important clinical concepts.
B. Pediatric Guidelines
1. An additional six hours of training in pediatric enteral conscious sedation
emphasizing physiology, metabolism, anatomy and pharmacological considerations
are required for the use of enteral conscious sedation in patients under 13 years of
age or less than 90 pounds.
2. It is suggested that practitioners who provide enteral conscious sedation maintain
current certification in Pediatric Advanced Life Support (PALS).
C. The Essential Knowledge Emphasized in Each Course
1. All dentists administering enteral sedation must have a sufficient and current
knowledge-base of the drugs he/she is administering, including the pharmacology,
indications, contraindications, dosing, adverse reactions, interactions and their
management.
D. Continuing Education
1. Nine hours of PACE and/or CERP approved courses directly related to the clinical
use of enteral sedation every three years. In addition, BLS (CPR) is required to be
current.
IV. Sedation Medications and Usage
A. Medications
1. Only those medications and techniques with which the practitioner is thoroughly
familiar should be used.
B. Dosages
1. Single Dosages
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a. No single dosage administration should exceed a single MRD in one dose
for that particular drug.
2. Multiple Dosages
a. Any medication that is used in multiple dosing beyond the MRD in
aggregate should be capable of being reversed.
1. The interval between dosing must be adequate to permit
evaluation of the CNS depressant effects of previously administered
medication(s).
2. No additional sedative medication(s) should be given when
acceptable sedation is noted as judged by patient or dentist.
C. Multiple Agents
1. Use of additional enteral conscious sedation medications and or inhalation
sedation (i.e. N2O-O2) should be done with caution due to the possible occurrence of
a greater level of CNS depression than desired.
2. Local anesthesia dosing limits must be clearly understood and adhered to in order
to prevent additive toxicity.
V. Monitoring
A. The following systems must be monitored during the sedation appointment (as
described below) to ensure the safety of the patient during enteral conscious sedation.
1. Central Nervous System (CNS)
a. Patient responsiveness to verbal command must be assessed every five
minutes following the administration of the medication until appropriate
discharge criteria are met.
2. Respiratory System
a. Auscultation of the airway prior to the sedation drug being administered in
addition to use of continuous pulse oximetry commencing at the time a
clinical effect of the sedation medication is first manifested and continuing
until appropriate discharge criteria are met.
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3. Cardiovascular System (CVS)
a. Blood pressure and heart rate must be assessed every 15 minutes
commencing at the time a clinical effect of the sedation medication is first
manifested and continuing until appropriate discharge criteria are met.
VI. Documentation
A. At a minimum, an enteral conscious sedation record must include the following:
1. Review of patient’s medical and pharmacological history sufficient to enable the
dentist to assign an ASA status and to assess risk factors in relation to sedation including
any adverse reactions to medications.
2. Physical evaluation to include patient’s age, weight and height; general appearance,
noting obvious abnormalities; and visual examination of the airway, such as range of
motion, loose teeth, potential obstruction from large tongue, tonsils, etc.
3. Informed consent for enteral sedation must include risks and alternatives and be
signed by the patient, parent or legal guardian prior to the administration of CNS
depressive medications by the patient, parent or legal guardian. A separate signed
consent form is required for each visit.
4. The sedation record should be time based and should include the information
described in Appendix I (attached).
VII. Discharge Protocol
A. Discharge Criteria for the Patient
1. Conscious and oriented
2. Vital signs are stable
3. Ambulatory with minimal assistance
B. Discharge Responsibility
1. Patient must be discharged from the office into the care of a responsible adult who
has a vested interest in the health and safety of the patient. Written and verbal
instructions must be provided, that include an admonition for the patient not to
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operate a motor vehicle or any dangerous equipment for a minimum of 18 hours or
longer if drowsiness or dizziness persists
2. Privacy information/HIPPA form for the escort to sign, if applicable.
C. Administration of Reversal Agents
1. If a reversal agent is administered before discharge criteria have been met, the
patient must be kept in a monitored environment for minimum of two hours.
Routine discharge criteria must also be met.
D. Post-operative Analgesia
1. With respect to post-operative analgesia, nonsteroidal anti-inflammatory drugs
(NSAIDs) should be encouraged.
VIII. Emergency Management
A. Responsibility of the Dentist
1. The dentist is responsible for the anesthetic management, adequacy of the
facility, and treatment of emergencies associated with the administration of
enteral conscious sedation, including immediate access to appropriate
pharmacologic antagonists and properly sized equipment for establishing a
patent airway and providing positive pressure ventilation with oxygen.v
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APPENDIX I
Sedation Record for Enteral Conscious Sedation
An enteral conscious sedation record should include the following information:

















Patient name
Date of procedure
Verification of accompaniment for discharge
Preoperative blood pressure, heart rate, and oxygen saturation
ASA status
Names of all medications administered
Doses of all medications administered
Time of administration of all medications
List of monitors used
Record of systolic and diastolic blood pressure, heart rate, oxygen saturation and level of
consciousness at 15-minute intervals
Time of the start and completion of the administration of the enteral/sedation
Time of the start and completion of the dental procedure
Recovery period
Discharge criteria met: oriented, ambulatory, vital signs stable (record of blood pressure, heart
rate, oxygen saturation)
Time of discharge
Name of the professional responsible for the case
A notation of any complications or adverse reaction
References
¹American Dental Association. Guidelines for the Use of Conscious Sedation, Deep Sedation, and
General Anesthesia for Dentists. Available at:
http://www.ada.org/prof/resources/positions/statements/anesthesia_guidelines.pdf. Accessed
November 9, 2005.
²Ibid.
³American Society of Anesthesiologists. ASA Physical Status Classification System. Available at:
http://www.asahq.org/clinical/physicalstatus.htm. Accessed November 9, 2005.
4
Malamed SF. Medical emergencies in the dental office. 6th edition 2006. C.V. Mosby, St. Louis.
5
American Dental Association. Guidelines for the Use of Conscious Sedation, Deep Sedation, and
General Anesthesia for Dentists. Available at:
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http://www.ada.org/prof/resources/positions/statements/anesthesia_guidelines.pdf. Accessed
November 9, 2005.
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Handling Legislation Regarding General Anesthesia and Sedation Guidelines
REGARDING BOTH GENERAL ANESTHESIA AND IV SEDATION
1.
All dentists, regardless of specialty status, should be deemed qualified to render particular
modalities of pain control based upon the same qualifications. membership in a specific
organization must not be used as a basis for permitting any individual to perform a given
modality of pain control.
2.
Part One of the ADA's Guidelines should be implemented as a basis for preparing dental school
undergraduates to render appropriate pain and anxiety control measures.
3.
The dentist must report to the State Board of Dental Examiners any mortality or any incident
occurring in the office which results in temporary or permanent, physical or mental injury
requiring hospitalization of said patient that is the direct result of dental general anesthesia or
sedation.
4.
The dentist is responsible for ensuring that the dental office is properly equipped and
maintained to safeguard the patient's overall health. The dentist should be prepared to
undergo an inspection and evaluation of the facility, equipment, personnel, and procedures
used in the office. At least one of the individuals conducting the inspection should be a
general dentist qualified to administer general anesthesia and IV sedation, wherever possible.
REGARDING GENERAL ANESTHESIA
1.
All dentists not covered by a grandfather clause who wish to administer general anesthesia
must complete education equivalent to the number of general anesthesia training hours
required in the current oral surgery residency programs. These hours may be acquired on
either a full time or part time basis. Dentists qualified under this section shall be encouraged
to take refresher courses.
2.
Laws enacted must contain a permanent grandfather clause. Demonstration by a general
practitioner that he/she has been administering general anesthesia successfully on a regular
basis for the last five years shall qualify that dentist as meeting the necessary educational
requirements for grandfathering.
3.
The dentist is responsible for seeing that an adequately trained individual is with him or her to
continuously monitor the patient under general anesthesia.
4.
A dentist who has not been trained in administering general anesthesia may obtain a special
permit to have general anesthesia administered in his/her office providing he/she has an
anesthesiologist, or a certified registered nurse anesthetist or the equivalent on the premises
until such time as the patient regains consciousness.
5.
A dentist who wishes to administer general anesthesia in his/her office should possess a
current certificate in Advanced Cardiopulmonary Life Support issued by the American Heart
Association, the American Red Cross, or an equivalent agency-sponsored cardiopulmonary
resuscitation course with recertification every two years.
REGARDING SEDATION
1.
Sedation can be learned on a CDE basis with reference to the course content described in Part
III of the ADA's Guidelines. The time and type of training should be subject to the approval of
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the Dental Board. This allows for a variety of programs in the same state so that dentists may
select the program most appropriate to their backgrounds.
2.
There is enough evidence to indicate that the clinical and didactic material for sedation can be
learned in the undergraduate and graduate levels, and through CDE on a continuous or
incremental basis. It is helpful if the course can be conducted in a hospital or dental school
environment. Consideration should be given to providing the course on an incremental basis
so that it will be available to more of the practicing profession.
3.
Laws enacted must contain a permanent grandfather clause. Demonstration by a dentist that
he/she has been administering sedation successfully on a regular basis for the last three years
shall qualify that dentist as meeting the necessary educational requirements for
grandfathering. Grandfathered dentists should be encouraged to take periodic refresher
courses.
Revised HOD 5/87
Revised HOD 7/94
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Handling Legislation Regarding General Anesthesia and Sedation
1.
All dentists, regardless of specialty status, should be deemed qualified
to render particular modalities of pain control based upon the same
qualifications. Membership in a specific organization must not be used
as a basis for permitting any individual to perform a given modality of
pain control.
2.
Part One of the ADA's Guidelines should be implemented as a basis for
preparing dental school undergraduates to render appropriate pain
and anxiety control measure.
3.
The dentist must report to the State Board of Dental Examiners any
mortality or any incident occurring in the office which results in
temporary or permanent, physical or mental injury requiring
hospitalization of said patient that is the direct result of dental general
anesthesia or sedation.
4.
The dentist is responsible for ensuring that the dental office is properly
equipped and maintained to safeguard the patient's overall health.
The dentist should be prepared to undergo an inspection and
evaluation of the facility, equipment, personnel and procedures used
in the office. At least one of the individuals conducting the inspection
should be a general dentist qualified to administer general anesthesia
and IV sedation, wherever possible.
Regarding general anesthesia
1.
All dentists not covered by a grandfather clause who wish to
administer general anesthesia must complete education equivalent to
the number of general anesthesia training hours required in the
current oral surgery residency programs. These hours may be acquired
on either a full time or part time basis. Dentists qualified under this
section shall be encouraged to take refresher courses.
2.
Laws enacted must contain a permanent grandfather clause.
Demonstration by a general practitioner that he/she has been
administering general anesthesia successfully on a regular basis for the
last five years shall qualify that dentist as meeting the necessary
educational requirements for grandfathering.
3.
The dentist is responsible for seeing that an adequately trained
individual is with him or her to continuously monitor the patient under
general anesthesia.
4.
A dentist who has not been trained in administering general anesthesia
may obtain a special permit to have general anesthesia administered in
his/her office providing he/she has an anesthesiologist, or a certified
registered nurse anesthetist or the equivalent on the premises until
such time as the patient regains consciousness.
5.
A dentist who wishes to administer general anesthesia in his/her office
should possess a current certificate in Advanced Cardiopulmonary Life
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Support issued by the American Heart Association, the American Red
Cross, or an equivalent agency-provided cardiopulmonary resuscitation
course with recertification every two years.
Regarding sedation
1.
Sedation can be learned on a CDE basis with reference to the course
content described in Part III of the ADA's Guidelines. The time and
type of training should be subject to the approval of the Dental Board.
This allows for a variety of programs in the same state so that dentists
may select the program most appropriate to their backgrounds.
2.
There is enough evidence to indicate that the clinical and didactic
material for sedation can be learned in the undergraduate and
graduate levels, and through CDE on a continuous or incremental basis.
It is helpful if the course can be conducted in a hospital or dental
school environment. Consideration should be given to providing the
course on an incremental basis so that it will be available to more of
the practicing profession.
3.
Laws enacted must contain a permanent grandfather clause.
Demonstration by a dentist that he/she has been administering
sedation successfully on a regular basis for the last three years shall
qualify that dentist as meeting the necessary educational requirement
for grandfathering. Grandfathered dentists should be encouraged to
take periodic refresher courses.
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National Health Care Reform Position Paper
EXECUTIVE SUMMARY
Reform to our nation's health-care system will require a significant restructuring of the current
delivery system. However, the Academy believes these changes should be incremental and should
build upon the strengths of our current system.
The Academy of General Dentistry believes that any health-care reform plan must require insurers to
offer a minimum benefits package, which would be developed and updated yearly by an
independent, federally established commission. Community rating would replace experience rating,
pre-existing condition exclusions would be prohibited and purchasing corporations or networks
would be established to allow the pooling of good and bad risks. In addition, a national risk pool
would be established for eligible individuals.
Employers would be encouraged to offer a basic benefits package to all employees. In addition,
strong incentives would be developed to promote the purchase of a comprehensive benefits
package, which includes dental services. Employers would be required to continue to offer, but not
pay for, coverage to employees who have been fired, laid off or have quit.
Medicaid could be expanded and made more efficient through a system of vouchers and subsidies
and aggressive anti-fraud measures. Uniform eligibility standards and a uniform basic benefits
package and catastrophic care, could be established and could be provided through managed care
systems that operate on a group model or on a clinic type (staff model) of delivery system.
Employees would be required to share in premium costs. Incentives would be developed to
encourage providers to practice in currently underserved areas and extensive professional liability
reforms would be implemented. Administrative costs and waste in the health delivery system would
be reduced, and living wills would be recognized.
STATEMENT OF GUIDING PRINCIPLES
The Academy of General Dentistry believes that the following principles must be the ultimate goal of
any health-care reform plan. It acknowledges that these goals may not be immediately achievable.
However, it affirms that these goals must be the guiding principles behind any reform plan.
The Academy believes that any health-care reform plan must:
1.
Provide access to basic health care for all legal residents of the United States,
regardless of income.
2.
Control escalating health-care costs.
3.
Provide high-quality health care.
4.
Build upon the strengths of the current system.
5.
Be based on an equitable tax policy.
6.
Preserve our pluralistic financing, reimbursement and delivery systems to allow
patients the freedom to choose their health-care providers and the manner in which
their health-care benefits are delivered.
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7.
Be adequately funded.
8.
Include a preventive component.
Rx FOR CHANGE
The Academy of General Dentistry supports incremental reforms to our nation's health-care system
that will build upon its current strengths while increasing access and decreasing costs. While gaining
control of costs is crucial, the Academy notes that the high quality of health care currently available
in the United States should not be compromised in any way.
The U.S. Department of Commerce estimates in its U.S. Industrial Outlook 1993 that, during 1992, of
the $838.5 billion spent on national health expenditures, $40.4 billion was spent on dentists' services,
compared to $157.1 billion on physicians' services.
The Commerce Department also found that outlays for physicians' services, home health care,
hospital care and nursing home care rose at significantly higher rates between 1987 and 1992 than
for dentistry. In fact, the increase in outlays for dentistry has been lower than nearly every other
area of health care. Dentistry is one of the few areas where expenditures are still increasing at single
digit rates. For example, the Commerce Department reports that from 1991 to 1992, spending for
dentistry rose 9.0 percent, while spending for physicians' services rose 10.6 percent during the same
time period.
The Academy's position on health-care reform addresses the issue in two parts: (1) broadening
access to care and (2) controlling costs.
I.
Broadening access to care.
Despite the fact that the United States spends more per capita -- and a greater proportion of its gross
domestic product -- than any other industrialized nation in the world on health care, millions of
individuals are falling through the cracks in our health-care system.
Two reports -- one released in December 1992 and the other in January
1993 -- although arriving at different figures, both confirm that the number of individuals without
health insurance coverage is steadily increasing, ranging from 35.4 million to 36.6 million in 1991.
Surprisingly, nearly three-fourths of all uninsured Americans are workers or their dependents,
according to a September 1992 General Accounting Office report.
The Academy believes that access to care could be improved by:
1.
Requiring private insurers to offer a federally established minimum package of
health-care benefits.
An independent commission may be formed to develop and update yearly a minimum
benefit package that all private insurers would be required to offer. The independent
commission should include representatives from all participants of the health-care
system: dentists, physicians, hospitals, government, business, labor, consumers and
insurers. This package should be weighted toward preventive benefits since these
services are most cost effective.
2.
Creating incentives for employers to provide comprehensive benefits packages to
their employees.
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More favorable circumstances should be created for employers to provide
comprehensive health benefits, including dental services, voluntarily. Incentives
should include providing employers with the choice of a tax credit or deduction to
encourage them to purchase the basic benefits package. The tax credit/deduction
should be the same for both large and small businesses.
The importance of a health-care tax credit/deduction is dramatically highlighted by a
January 1993 report released by Communicating for Agriculture (CA), a national rural
non-profit advocacy organization. CA found that the loss of the 25 percent deduction
for the cost of health insurance benefits for the self-employed is likely to lead to an
additional 400,000 uninsured individuals.
However, given the current political and financial climate, the Academy recognizes
that a full 100 percent deduction or tax credit may not be feasible. Therefore, the
Academy stresses that whatever limit is finally established be equitable. Large and
small businesses, incorporated firms and self-employed individuals should all be given
an equal deduction.
The Academy also believes that funds raised by limiting the deductibility of
health-insurance benefits should be used to expand access to health care, not to build
highways or for any other reason.
3.
Encouraging employers to offer a basic benefits package to all employees.
Employers should offer a basic benefits package to all employees. To encourage this,
no employer should be allowed to deduct any part of his/her health-insurance
premiums unless he/she offers the basic package to all employees. This will
discourage large employers from offering health benefits only to upper management,
and it will discourage small employers from only purchasing health insurance for
themselves.
4.
Giving temporarily unemployed persons continued coverage at group rates, and
making premium payments tax deductible up to the maximum allowable limit.
This would provide a much-needed safety net for United States workers. Employers
should be required to offer, but not pay for, a basic package for this group at regular
group rates. This coverage should be offered regardless of the reason for the
individual's unemployment. For example, an employer must not be allowed to deny
continued coverage simply because a person was fired, laid off or has quit. The
payments made for health insurance by the individual should be tax deductible up to
the maximum allowable limit.
5.
Reforming the insurance market to assure affordable basic benefits for small groups.
Reforms to the insurance industry are fundamental to any solution to the
health-insurance problem. Establishing community rating in place of experience rating
would reduce the cost of health insurance and make fees more stable from year to
year for small businesses and uninsurables by spreading risks. Consequently, if an
employee in a small business finds it necessary to utilize health benefits in a given
year, he/she won't necessarily increase the rates for his/her company. This, in turn,
will encourage more small businesses to provide health-insurance benefits to their
employees.
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Other necessary reforms include prohibiting pre-existing condition exclusions and
developing purchasing corporations or networks to allow the pooling of good and bad
risks within small employer pools.
In addition, self-employed persons, unemployed but self-sufficient persons, and adult
students should be combined into a national risk pool with coverage provided by
private insurers at rates no greater than 125 percent of the group rate for comparable
coverage.
6.
Reforming Medicaid.
Medicaid should be expanded and made more efficient to reduce costs and to improve
access to health-care. There should be uniform eligibility standards across the nation,
and a standard benefits package should be developed. The standard benefits package
should include a long-term and catastrophic care insurance benefit and preventive
services. These benefits should be provided to Medicaid recipients through
cost-effective managed care systems that operate on a group model, staff model or
clinic type of delivery system.
Medicaid should be expanded to include all categorically impoverished persons, and
should cover workers who are not covered under their employer's insurance plans.
Low-income individuals should receive assistance in purchasing the basic package of
Medicaid benefits through a series of vouchers and subsidies on a sliding scale based
on income. The poorest individuals should receive a non-transferable voucher for the
purchase of the coverage, and other low-income individuals should receive a subsidy
to assist them in purchasing the basic benefit package. This expansion should be paid
for by both the federal and state governments.
Medicaid fees should be made comparable to Medicare, and providers must be
adequately compensated. Properly compensating health-care providers will prevent
cost-shifting and ensure a high standard of care. The importance of adequate funding
is highlighted by an April 1992 report released by the Healthcare Financial
Management Association (HFMA). HFMA found that reimbursement shortfalls from
Medicare and Medicaid are comprising an increasingly larger share of hospital
cost-shifting. In 1989, the estimated level of under-compensated care from public
payers -- $11.2 billion -- was "reasonably close" to the cost of unsponsored care
provided to patients in the form of bad debt and charity care -- $8.9 billion. By 1992,
however, the study estimated that undercompensated care from public payers would
reach $22.7 billion compared to about $11.9 billion for unsponsored care.
*
Aggressive measures should be taken to eliminate fraud and corruption. For example,
a data base of all final adverse actions and certain fraud investigations against
health-care practitioners should be established. However, such a system must ensure
patient confidentiality. The importance of anti-fraud measures is highlighted by
testimony presented to Congress in February 1993 by William Mahon, executive
director of the National Health Care Anti-Fraud Association, who said that health-care
fraud and abuse could cost the nation as much as $94 billion in 1993.
The reformed Medicaid should be transferred to the private sector with at least one
hospital-medical-surgical-dental benefit plan or carrier in each state.
7.
Instituting a federally supported system of financial incentives for providers in
underserved areas.
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Financial incentives, such as loan forgiveness, would make less desirable geographic
and socio-economic areas more attractive to health-care providers, and would thereby
increase the availability of quality health care to all residents.
*
II.
The Board recommended that the third sentence in this paragraph be amended to
read "... must ensure patient confidentiality and provider due process." The Board
also recommended that the entire paragraph be moved to the last page of the paper,
numbered as item 6, and given the title "Eliminating Fraud and Corruption."
Controlling escalating health-care costs.
Controlling escalating costs is crucial to reducing the burgeoning deficit. In addition, reducing
health-care costs is one factor that will help United States firms successfully compete in the global
marketplace.
According to a September 1992 General Accounting Office report, a survey of medium and large firms
found that employer and employee health-benefit costs grew at an average annual rate of 16 percent
over the past four years. And, small firms have been experiencing even larger increases.
The Academy believes costs could be controlled by:
1.
Implementing tort/professional liability reforms.
Any professional liability reforms must enhance the injured individual's ability to
obtain fair compensation and at the same time protect doctors from predatory and
unjustified law suits. Tort reforms should include establishing mandatory periodic
payments of substantial awards for damages, imposing a ceiling on non-economic
damages, implementing mandatory offsets of awards for collateral sources of
recovery, limiting attorney's contingency fees, imposing a statute of limitations on
health-care-related injuries, devising alternative methods of resolving disputes and
requiring medical facilities to use risk management practices.
The National Medical Liability Reform Coalition found in a February 1993 report that
the nation's health-care system could save as much as $76 billion over the next five
years by reducing or eliminating the practice of "defensive medicine" through
implementing reforms such as these.
2.
Limiting administrative costs.
Simplifying administrative procedures and making insurance forms uniform would
reduce costs significantly. In addition, implementing an electronic claims processing
system would streamline the process, thereby reducing costs. A November 1990
report by Families USA Foundation and Citizen Action estimated that $52.8 billion
could be saved by simplifying the insurance administrative system of private health
insurance.
3.
Reducing oversupply of hospital beds and duplicative expensive technology.
Unused hospital beds provide no benefit and contribute to the drain on our limited
resources. Reducing the oversupply of beds would help to reduce costs as would
reducing duplicative technology. A June 1991 General Accounting Office report found
that the medical "arms race" is a significant contributor to rising health-care
expenditures. One example the report gave was of a county in Pennsylvania. In this
county, a hospital and a group of radiologists each acquired MRI machines. But
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another MRI machine also serving local residents was already available in the next
county. As a result, a small area had three sophisticated diagnostic machines, each
costing $1.5 million. With those machines, physicians apparently performed more MRI
scans per resident than were done in all of Philadelphia and many other hospitals in
the state.
4.
Requiring employees to share in premium costs, but make employees' contributions
deductible up to the maximum allowable limit.
Requiring employees to share in premium costs is an easy way to promote wiser
consumer choices. Additionally, copayments would help to encourage greater
personal responsibility on the part of the patient, and to decrease frivolous use of the
health-care system without unduly burdening those who truly need to use it.
5.
Recognizing living wills in law.
By respecting the wishes of our terminally ill patients and legally recognizing living
wills, we could reduce health-care expenditures for the terminally ill.
Adopted HOD 7/93
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Position Statement on the Advanced Dental Hygiene Practitioner
(ADHP) Concept
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AGD Dental Practice Council, February 2008
Approved, AGD HOD, July 2008
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Introduction
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In 2001, Oral Health in America: A Report of the Surgeon General unveiled a
maldistribution in access to dental care across socioeconomic geographies. The
Academy of General Dentistry (AGD) is dedicated not only to correcting the
maldistribution in access to dental care, but furthermore, to providing nondiscriminatory access to quality dental care.
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In 2003, the AGD was the first dental professional organization to enter into a
Memorandum of Understanding (MOU) with the U.S. Department of Health
and Human Services (HHS) in an effort aimed at eliminating oral health
disparities, increasing the public’s understanding of oral health issues, and
expanding access to and utilization of dental care services. Other federal health
agencies signing the MOU included the Centers for Disease Control and
Prevention (CDC), the Office of Public Health and Science, the Health Resources
and Services Administration (HRSA), the Indian Health Service (IHS), and the
National Institutes of Health’s (NIH) National Institute for Dental and
Craniofacial Research (NIDCR).
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In its endeavor to eliminate oral health disparities, the AGD has engaged in
federal lobbying and state advocacy efforts to support Medicaid and SCHIP
programs, and funding thereof. Additionally, the AGD has supported the
funding of Title VII dental residency programs. Further, the AGD has promoted
patient education, and worked to eliminate impediments to competitive
payment by third party payers, include Medicaid contractors, to dentists
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serving socio-economically disadvantaged populations. Moreover, the AGD
encourages its approximately 35,000 members and all general dentists to
volunteer their services to needy persons through programs such as Donated
Dental Services and Give Kids a Smile. Further, AGD volunteers participate
through the Special Olympics provider directory to provide services to persons
with intellectual disabilities.
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The thread that ties all of the AGD’s endeavors on access to care, and
constructs the very fabric of the AGD’s belief, is that underserved and needy
populations deserve the same quality of dental care as all Americans. Simply
stated, reserving a lower quality of care for those facing depressed or
oppressed socioeconomic conditions creates a separate and unequal standard
to which the underserved are undeserved.
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Advanced Dental Hygiene Practitioner (ADHP)
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What is an ADHP?
The ADHP, a concept developed by the American Dental Hygienists’ Association
(ADHA), is one of numerous concepts for midlevel dental workforce models
which have been introduced as solutions to the challenge of offsetting the
maldistribution in access to care. According to the ADHA’s Draft Competencies
for the Advanced Dental Hygiene Practitioner (“Draft Competencies”), released
in June 2007:
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The ADHP is proposed as a cost-effective response to the oral health
crisis. The ADHP will work in partnership with dentists to advance the
oral health of patients. This new practitioner will provide diagnostic,
preventative, therapeutic and restorative services to the underserved
public in a variety of settings and will refer those in need to dentists and
other healthcare providers. P.6.
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How does the ADHP differ from other allied dental models?
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While the ADHP may work in partnership with dentists, the ADHP concept is
designed for independent practice. Unlike alternative allied dental models,
such as Alaska’s Dental Health Aide Therapists (DHAT) and the American Dental
Association’s (ADA) proposed community dental health coordinator (CDHC), an
ADHP may work without direct, indirect, or general supervision by a dentist,
and without any standing orders or dentist review. That is, the ADHP may fall
completely outside the scope of the dental team concept.
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However, what appear to be simple fillings or simple extractions may become
complicated. For example, a simple filling may open into the nerve of a tooth,
presenting an opportunity for the development of an abscess, which, if
improperly treated, may become life-threatening. Without the immediate
availability and resources of a dental team, the ADHP may be unable to avail
himself or herself of the expertise and services of a dentist within the
appropriate timeframe to provide the patient with the necessary care.
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According to AGD policy, “the AGD supports the dental team concept as the
best approach to providing the public with quality comprehensive dental care.”
Dentistry, unlike medicine, has its focus on preventative care. The dental team
concept provides the patient with a dental home for continuity of
comprehensive care with a focus on prevention and treatment to mitigate the
need for critical care.
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On the other hand, ADHP’s will likely find it less economically feasible to
maintain an independent practice without a dentist in the more underserved
areas. These underserved areas may include remote rural areas or areas with
high indigent populations who are most in need of dental care but least able to
pay for it. The dental team concept, with the dentist in direct or indirect
supervision of the practice, provides the hygienist with the economic
protection and freedom to expand his or her practice to serve the needs of lowincome populations through expanded services such as the provision of hygiene
education and case management services (especially in the public health
setting). Further, the team concept provides the accessibility to the knowledge
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and resources needed to address complications and compromised systemic
health conditions that often plague the indigent and presently underserved.
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Additionally, the ADHA’s Draft ADHP Competencies note that independent
ADHPs would establish collaborative relationships with dentists and their
dental teams, including traditional hygienists, and further, would refer their
patient to the dentists as they deem appropriate. However, given the finding
that there may be a maldistribution of dentists in underserved areas, access to
opportunities for aforementioned collaboration and referral may meet the
same challenge as the patients’ access to quality care itself. That is, without
dentist supervision through a dental team concept, the independent midlevel
provider may only serve the patient as an intermediary of time and money lost,
not of care gained.
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How does an ADHP differ from a dentist?
Without any dentist supervision or oversight, the ADHP purports to offer
comprehensive oral health care in an independent setting except where the
ADHP deems that referral to a dentist is needed. As noted above, the
comprehensive oral health care purports to include diagnostic, surgical, and
irreversible restorative services. In fact, the ADHA’s Draft Competencies cite an
excerpt of the American Dental Educators Association (ADEA) report,
Unleashing the Potential, which reads, “the dental hygienist can substitute for
the dentist where there is none.” P. 7.
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Given that the unsupervised practice of an ADHP would mirror that of a dentist
in the services provided, inclusive of diagnoses and irreversible procedures that
are presently reserved for dentists, one must examine whether the education
and training of the ADHP meets the minimal competencies required of the
dentist in the performance of the same procedures.
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The ADHA proposes an ADHP master’s degree curriculum to provide the
hygienist with the competency required to provide diagnostic, therapeutic,
preventative, and restorative services. However, notwithstanding that there is
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currently no Commission on Dental Accreditation (CODA) approved ADHP
master’s degree program, dental school curricula designed to graduate DDS
recipients are structured only to meet the minimum standards for competency
in dentistry as set by ADEA for CODA accreditation. Competency achieved
through graduate dental education toward a DDS or DMD degree sets the floor,
and not the ceiling, for the practice of clinical dentistry. If these are the
minimum standards, anything less could not render a practitioner competent to
perform dentistry.
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Therefore, an ADHP master’s degree curriculum, regardless of CODA
accreditation, cannot meet the minimum standards of competence to provide
dentistry, especially diagnostic and irreversible dentistry, unless the ADHP
master’s degree curriculum were to adopt the prerequisites of dental school
entry and meet or exceed the competencies achieved through dental school.
That is, the ADHP master’s degree candidate would essentially have to earn a
dentist’s degree to qualify as a practitioner of the aforementioned dental
procedures.
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Since the educational framework proposed by the ADHA is intended to fall
short of comprehensive dental school curricula, the quality of care provided by
an ADHP would fall short of the minimal competency required of a dentist.
One could argue that the benefit of competent care in dentistry is already a
commodity only available to those who can afford it, and that those who
cannot afford it presently get nothing. However, it is the AGD’s position that
those who cannot afford dental care nonetheless deserve the same quality and
competence of care as all.
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Further, provision of a lesser quality of care to poorer populations conveys the
illusion of care to the patient who might believe that the intermediate
patchwork of a midlevel provider is sufficient while in fact clinical care by a
dentist is required. Notwithstanding the inherent injustice in providing lesser
quality (and potentially unsafe) care to more needy patients, one must also
consider that disadvantaged populations have often neglected their dental
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health for years, thereby causing complications not as readily prevalent in the
more advantaged communities. Further, lower quality patchwork dentistry,
without the benefit of dentist supervision or a dental team home, may conceal
underlying medical concerns and undermine dentistry and healthcare’s growing
effort to address dentistry as a doorway for prevention of numerous systemic
ailments.
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How does the ADHP differ from advanced nurse practitioners?
The ADHA draws upon the advanced nurse practitioner model as setting
precedent for the ADHP model. However, the ADHP and advanced nurse
practitioner differ fundamentally in the models in which they practice, or
intend to practice.
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The dental concept and medical concept are vastly different. In the medical
concept, the patient’s first contact is just the “point of entry.” Rich with
diagnostic codes, the medical model focuses on a first diagnosis at the patient’s
“point of entry,” and often a second or third diagnosis based upon the direction
of referral. Therefore, in the medical model, the first diagnosis, regardless of by
whom, merely opens the gateway to further evaluation, and need not disturb
subsequent diagnosis or continuity of care
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On the other hand, dentistry has served its patients quite well through a
“dental team concept,” rather than a “point of entry” concept. The dental
team concept serves the function of dentistry and patients’ access to care with
its focus not merely on diagnosis of dental diseases, but rather, on prevention
and continuity of care through treatment. That is, in dentistry, the “point of
entry” is the point of prevention and treatment, and not just a segue, thereby
saving time and cost.
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Further, treatment by a dental team varies within acceptable standards of care
based upon the assessments, competencies and preferred methodologies of
the core dentist. Therefore, fragmentation of diagnosis or preliminary
treatment shall not only fragment the dental team concept and dentistry’s
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holistic view of treatment, but also access to consistent quality care. That is,
care shall be rendered discontinuous.
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Therefore, while one can appreciate the medical model’s efforts at a solution to
access to care with the adaptation of the nurse practitioner, a similar model
would likely have the opposite effect in dentistry; that is, it would disrupt
continuity of care and access to quality of care for patient populations.
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Access to Quality Care, In Summary
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Defining the challenge in providing access to quality care is the first step to
addressing the challenge. Access to quality care has two components: access
and quality. Quality is necessary to ensure patient safety.
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Accessibility without quality echoes the “something is better than nothing”
approach to care. However, this approach serves only injustice, and not the
public need. A court of law does not provide an indigent defendant with a
paralegal if he or she cannot afford an attorney. Likewise, accessibility in
dentistry is meaningless without equivalent quality care.
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Creation of the ADHP concept offers a divergence from the goal of access to
quality care. The additional education required under the ADHP model
provides students who might otherwise pursue a DDS or DMD with an avenue
to spend time and money to earn a title that signifies the ability to provide a
quality of care that falls short of the minimum competence required to practice
dentistry, especially as related to diagnosis and irreversible procedures.
Further, without the minimal education of a dentist, the ADHP may
compromise the safety of the patient, and raise questions of assignment of
liability.
Additionally, an ADA study1 revealed that, when provided the opportunity to
practice independently to serve the needy, the overhead of maintaining a
practice drives independent midlevel practitioners away from underserved
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areas. Presuming that the pilot study serves as a microcosm, the ADHP concept
would fail to provide any indigent care, even that which falls short of the
minimal standards of quality and safety. On the other hand, if the ADA study
does not serve as a just microcosm, the practice of dentistry by one who has
not attained the minimal qualifications of a dentist would nonetheless fall short
of said minimal standards.
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Given that dentistry, unlike medicine, has a focus on prevention and treatment,
and is therefore best served by a point-of-service approach, the AGD supports
the dental team concept as the best methodology to providing quality
comprehensive care to all patients. The AGD also recognizes socio-economic
divisions in the maldistribution in access to care. However, the AGD
understands that underserved populations are at the greatest risk for oral and
systemic disease, at the greatest need for high-quality comprehensive dental
care and continuity of care, and therefore, least served by intermediate
patchwork that may mask the recognition of a need for comprehensive care.
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As stated above, the AGD is a leading proponent of making the dental team
concept, with dentist supervision, accessible as a cornerstone of quality
comprehensive care for underserved populations. The AGD has worked
vigorously with state and federal agencies, dental schools, and other avenues
to promote public funding, volunteerism, and loan forgiveness for dental
students working in underserved areas, among numerous other efforts.
However, the ADHP concept offers a diversion of focus, direction, and
resources from these efforts, and an opportunity for separate and unequal
care, if any, for populations that deserve the same quality as all Americans.
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Brown, L.J., House, D.R., & Nash, K.D. The Economic Aspects of Private
Unsupervised Hygiene Practice and Its Impact on Access to Care. Dental Health
Policy Analysis Series. American Dental Association, 2005
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Referring Dental Patients to Specialists and Other Settings for Care General Guidelines
INTRODUCTION
Appropriate referrals are part of complete, quality health care management. Dentists' predoctoral
training in oral diagnosis and treatment planning teaches them that referrals are an essential part of
managing their patients healthcare needs. Dentists are expected to recognize the extent of their
patient's treatment needs and when referrals are necessary. These Guidelines address the
mechanics of dental referrals. They assume the dentist has the requisite skill and knowledge in
diagnosis and treatment planning to determine when a referral is needed.1
The following citations are found in the American Dental Association's Principles of Ethics and Code
of Professional Conduct:
2.B. CONSULTATION AND REFERRAL
Dentists shall be obliged to seek consultation, if possible, whenever the welfare of patients will
be safeguarded or advanced by utilizing those who have special skills, knowledge, and
experience. When patients visit or are referred to specialists or consulting dentists for
consultation:
1.
The specialists or consulting dentists upon completion of their care shall return the
patient, unless the patient expressly reveals a different preference, to the referring
dentist, or if none, to the dentist of record for future care.
2.
The specialists shall be obligated when there is no referring dentist and upon a
completion of their treatment to inform patients when there is a need for further
dental care.
2.B.1. SECOND OPINIONS
A dentist who has a patient referred by a third party* for a "second opinion" regarding a
diagnosis or treatment plan recommended by the patient's treating dentist should render the
requested second opinion in accordance with this Code of Ethics. In the interest of the patient
being afforded quality care, the dentists rendering the second opinion should not have a vested
interest in the ensuing recommendation.
* A third party is any party to a dental prepayment contract that may collect premiums, assume
financial risks, pay claims, and/or provide administrative services.
4.B. EMERGENCY SERVICE
1
The American Dental Association officially recognizes nine specialty areas of dental practice: oral
and maxillofacial surgery, orthodontics and dentofacial orthopedics, pediatric dentistry, periodontics,
prosthodontics, endodontics, oral and maxillofacial pathology, oral and maxillofacial radiology, and
dental public health. The procedures for referral to specialists, consulting dentists and other settings
of care are generally the same. Therefore, for the sake of simplicity, the term "specialists" in these
general guidelines can be read to include non-specialists and other settings to which the treating
dentist makes a referral. The referral process is an integral part of dental practice. These guidelines
place special emphasis on communications and facilitating and improving the referral process.
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Dentists shall be obliged to make reasonable arrangements for the emergency care of their
patients of record. Dentists shall be obliged when consulted in an emergency by patients not
of record to make reasonable arrangements for emergency care. If treatment is provided, the
dentist, upon completion of such treatment, is obliged to return the patient to his or her
regular dentist unless the patient expressly reveals a different preference.
SITUATIONS OR CONDITIONS NECESSITATING A REFERRAL
Patients may need to be referred for several reasons. Any one or any combination of the following
situations or conditions may provide the dentist with appropriate rationale for referring a patient:
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level of training and experience of the dentist
dentist's areas of interest
extensiveness of the problem
complexity of the treatment
medical complications
geographic proximity of specialists
patient load
availability of special equipment and instruments
staff capabilities and training
patient desires
behavioral concerns
developmentally disabled or handicapped patients
desire to share responsibility for patient care
ELEMENTS OF DENTAL PATIENT REFERRALS
Interprofessional Communication Needs: General Dentists who initiate patient referrals should
convey appropriate information to the specialists and determine on a case-by-case basis what
information should be transferred from the following list:
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name, address of the patient
appointment date and time
reason for the referral
general background information about the patient which may affect the referral
medical and dental information, which may include
- medical consultations and specific problems
- previous contributory dental history
- models
- radiographs
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projected treatment needs beyond the referral
urgency of the situation, if an emergency
information already given or told to patient
Additional information may be found below in the section titled, "Facilitating and Improving the
Referral Process."
Communications from the General Dentist to the Patient: Many times the referral process is foreign
to dental patients who have become accustomed to receiving their routine care at one specific office.
It is essential that all parties involved understand what is necessary to complete the referral
successfully. The following points should be considered:
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an assessment of the patient's ability to understand and follow instructions
explanation of the problem to parent or guardian, if the patient is a minor
indication of which area of dentistry or specialty is chosen and why
a specific appointment made while the patient is in the general dentist's office
if known and requested by the patient, information about the specialist's fee for the
initial consultation or examination
instructions that will assist the patient's introduction to the specialist; i.e., directions to
the specialist's office
Communication from the Specialist to the Patient: The specialist should provide the following
information to the patient:
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details of the referral services, fees and payment options
proposed additional and alternative treatment
details regarding the coordination of future treatment
follow-up appointment(s) if needed, and a return to the general dentist for completion
of other treatments and/or maintenance
Communication Between the Specialist and the General Dentist: Communication between
professionals is essential. Patients should receive clear, consistent information about their dental
problems and treatment from all dental professionals. Mixed messages can confuse and frustrate
patients and can undermine their confidence in the care provided.
It is the role of the general dentist to manage the overall dental health care of the patient. When
appropriate, any care rendered by a specialist should be coordinated with that of a general dentist,
with a clear understanding of the role of each in providing care to the patient.
The following steps can facilitate the communication process:
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initial report indicating the preliminary diagnosis by the specialist and anticipated
treatment
progress report, if treatment is extended over a considerable period of time
final report which includes such things as adverse experiences and maintenance
instructions plus recommendations for additional treatment
any copies or duplicates of appropriate pre-operative or post-operative radiographs
taken by the specialist.
return of any original radiographs or forms provided by the referring dentist
FACILITATING AND IMPROVING THE REFERRAL PROCESS
Personal knowledge of the specialist provider will allow patient need to be met most appropriately.
Dentists may wish to begin by looking for specialists with skills, knowledge, experience, and caring
attitudes which complement their own. Inquiries about the specialists' training and experience,
including their participation in continuing education and study clubs, may assist the dentist in
determining where to refer particular cases. A visit to the specialist's office to observe treatment
may be helpful.
The primary referring dentist and the specialist should also discuss cooperative working
arrangements which would benefit patients being referred. Both practitioners should discuss the
referral treatment period and the return of the patient to the primary dentist. This arrangement
could be enhanced by an exchange of business cards, referral forms, and patient instructional
materials. Availability of the specialist for emergency treatment as well as mid-treatment referrals
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should be discussed. Radiographs should be promptly forwarded to the specialist and returned to
the primary dentist.
Encouraging patient's questions about the referral and responding in lay terminology can ease some
of the fears associated with unfamiliar treatments or providers. If language barriers exist, every
effort should be made to ensure that the patient fully understands the reasons for the referral.
LEGAL AND ETHICAL ISSUES
Dentists should conduct themselves professionally and with dignity throughout the referral process.
In addition to the therapeutic issues which form the basis for the referral, there are also legal and
ethical considerations.
Legal Considerations: Dentists should recognize that separate and possibly conflicting legal interests
may be involved during a referral. Particular attention should be directed toward patients or
providers whose interests and requirements are detailed in contract form. When dentists or patients
participate in such arrangements related to dental services, these arrangements should be reviewed
carefully with respect to restrictions that may be placed on the dentist's ability to refer patients to
other settings or providers for care.
Note: In some situations, a dentist could be held legally responsible for treatment performed by
referral dentists. Therefore, dentists should independently assess the qualifications of participating
referral dentists as it related to specific patient needs. The dentist is reminded that contract
obligations do not alter the standard of care owed to all patients.
Ethical Considerations: Dentists should discuss their referral information with the patient in an
appropriate manner. The ADA Principles of Ethics and Code of Professional Conduct Section 4.C.
contains the following:
4.C. JUSTIFIABLE CRITICISM
Dentists shall be obliged to report to the appropriate reviewing agency as determined by the
local component or constituent society instances of gross or continual faulty treatment by
other dentists. Patients should be informed of their present oral health status without
disparaging comment about prior services. Dentists issuing a public statement with respect to
the profession shall have a reasonable basis to believe that the comments made are true.
ADVISORY OPINION
4.C.1. MEANING OF “JUSTIFIABLE”
Patients are dependent on the expertise of dentists to know their oral health status.
Therefore, when informing a patient of the status of his or her oral health, the dentist should
exercise care that the comments made are truthful, informed, and justifiable. This may involve
consultation with the previous treating dentist(s), in accordance with applicable law, to
determine under what circumstances and conditions the treatment was performed. A
difference of opinion as to preferred treatment should not be communicated to the patient in
a manner which would unjustly imply mistreatment. There will necessarily be cases where it
will be difficult to determine whether the comments made are justifiable. Therefore, this
section is phrased to address the discretion of dentists and advises against unknowing or
unjustifiable disparaging statements against another dentist. However, it should be noted
that, where comments are made which are not supportable and therefore unjustified, such
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comments can be the basis for the institution of a disciplinary proceeding against the dentist
making such statements.
Adopted by the AGD House of Delegates, 7/90
Editorially Revised by the AGD Dental Practice Council, 10/06
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Universal Access to Health Care Position Paper
The Academy of General Dentistry recognizes that resolving the issue of access to health care is
becoming increasingly urgent. This national problem affects Academy members on a variety of
levels: As health care providers, small business owners, self-employed persons, and as members of a
national organization taking a part in a national debate. This position paper has been drafted from
the perspective of the dentist as an employer and small business owner seeking to influence public
policy. It recognizes that for fiscal reasons, dentistry is not likely to be included in a universal health
program or other broad-based efforts to provide care to the uninsured. It should be noted that this
document represents the Academy's current position, which may change as the approaches to and
consequences of health care reform become more apparent.
1.
Do Not Mandate Employer Coverage
AGD opposes employer mandates because such laws may increase health care costs, reduce
employers' incentives to hire full-time staff members, increase a trend toward
underemployment of auxiliaries, and reduce incentives for employers to provide health care
benefits since such laws place solo and small group practitioners at an economic disadvantage.
Broad-based employer-provided health insurance coverage could be dramatically expanded
through a full tax deduction for the costs of health insurance premiums for all businesses and
through other tax reforms, coupled with insurance reforms, professional liability reforms,
Medicaid and Medicare reforms, and innovative cost containment practices. Creating more
favorable conditions for businesses to attain health insurance would relieve much of the
pressure on the federal government so that it could focus on insuring the indigent and
unemployed.
2.
Voluntary Uniform Benefits Package
The Academy supports establishing a recommended federal standard for a minimum benefits
package. Incentives should be created to encourage compliance with this standard in order to
eliminate the inconsistencies between benefits packages offered under various state laws.
3.
Implement Insurance Reform Provisions
Reforms to the insurance industry are fundamental to any solution to the health insurance
problem. The reforms must be extensive, restructuring the way health insurance is
administered nationwide.
A first step is to establish community rating in place of experience rating. This would reduce
the cost of health insurance and make fees more stable from year to year for small businesses
and uninsurables by spreading risks. Consequently, if an employee in a small business finds it
necessary to utilize health benefits in a given year, he/she won't necessarily increase the rates
for his/her entire company. However, community rating must be coupled with patient
copayments. This would encourage greater personal responsibility on the part of the patient
and decrease frivolous use of the health care system.
Other necessary reforms include banning new pre-existing condition exclusions for individuals
who have been continuously insured. Insurance underwriting practices that prevent the
pooling of good and bad risks within small employer pools must be restricted. A voluntary
state certification of insurers based on their costs, efficiency, and quality of service should be
implemented to help encourage insurers to compete on service rather than risk.
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4.
Provide Tax Incentives for Small Businesses
In order to make the health insurance market more accessible, particularly to small businesses,
unincorporated firms, and the self-employed, a full tax deduction must be offered to all
businesses and to individuals who must pay 100 percent of their health care premiums. In
addition, state and federal impediments to multiple employer trust arrangements should be
removed.
5.
Implement Medicare/Medicaid Reforms
Reforming Medicaid is an essential component for reform of the health insurance system.
Health care for the indigent should be provided by federal and state governments through an
expansion of Medicaid. In addition, workers who are unable to obtain insurance from their
employers would receive coverage under Medicaid regardless of income, with premiums set
on a sliding scale based on the worker's income. Eligibility for Medicaid must be uniform
throughout the United States. Further, Medicare should add a benefit to assist individuals in
paying for long-term care insurance.
The cost of Medicaid reforms must be self-financing in order to minimize tax increases.
Corruption in the Medicaid system must be eliminated and fraud controlled. In order to
increase participation by health care providers in the Medicaid system, reimbursement rates
need to be increased. This would also serve to improve the quality of the service Medicaid
recipients receive.
There must be no option for employees not to be insured. Should an employee refused
coverage under his/her employer's plan and not be covered elsewhere, then he/she must be
covered through either a payroll deduction or a line-item deduction on his/her tax form.
6.
Financing Mechanism
Reforms to the insurance marketplace, coupled with professional liability reforms and cost
containment initiatives (co-insurance, deductibles, etc.), should make health insurance more
affordable. The federal government would be responsible for providing care for the indigent,
and individuals would have increased responsibility through cost-sharing (co-payments) in
every insurance plan.
7.
Institute Professional Liability Reforms
Any professional liability reforms must enhance the injured individual's ability to obtain fair
compensation and at the same time protect doctors from predatory and unjustified law suits.
Tort reforms including limits on contingency fees and punitive damages must be implemented,
and alternate dispute resolution systems must be established. Medical facilities should be
required to use risk management practices.
8.
Cost Containment
To help keep the costs of health care insurance down to a minimum, consumers would have
access to ratings of hospital efficiency and quality and wellness education. This would
encourage hospitals to compete based on quality, cost and efficiency. Individuals would be
encouraged to make cost-effective management and treatment decisions with the help of
deductibles, co-payments and tax incentives. Incentives should be provided to eliminate costly
and inefficient paperwork.
9.
Long-Term/Catastrophic Care Provisions
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Tax incentives would help encourage the purchase of long-term/catastrophic care insurance.
Increased consumer protections, Medicare assistance for purchasing long-term/catastrophic
care, and a sliding subsidy for low-income beneficiaries should be implemented. Medicaid
coverage should be included for those below the national poverty level. In addition,
protection against impoverishment must be part of any long-term/catastrophic care plan.
Adopted HOD 7/91
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WHITE PAPER
ON INCREASING ACCESS TO AND
UTILIZATION OF ORAL HEALTH CARE
SERVICES
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“to serve and protect the oral health of the public”
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Academy of General Dentistry (AGD)
White Paper on Increasing Access to and Utilization of Oral Health Care Services
EXECUTIVE SUMMARY
While patients who have availed themselves of dental services in the United States have enjoyed the
highest quality dental care in the world, many patients are underserved presently, thereby raising the
need to address both access to care and utilization of care. Access to care refers to the availability of
quality care, and utilization of care refers to the behavior and understanding necessary by patients to
seek care that is accessible.
Illnesses related to oral health result in 6.1 million days of bed disability, 12.7 million days of
restricted activity, and 20.5 million days of lost workdays each year.1 However, unlike medical
treatments, the vast majority of oral health treatments are preventable through the prevention
model of oral health literacy, sound hygiene and preventive care available through the dental team
concept.
However, present efforts to institute independent mid-level providers—lesser educated providers
who are not dentists—to provide unsupervised care to underserved patients are not only
economically unfeasible but also work against the prevention model. Because underserved patients
often exhibit a greater degree of complication and other systemic health conditions, the use of
lesser-educated providers risks jeopardizing the patients’ health and safety. This approach will
provide lesser quality care to the poor.
Instead, solving the access to and utilization of care issues, thereby bridging the gap between the
‘haves’ and the ‘have-nots,’ requires collaboration among professional organizations, local, state, and
federal governments, community organizations and other private entities. This collaboration must
strive toward a multi-faceted approach that focuses on oral health literacy, incentives to promote
dentistry and dental teams in underserved areas (including through increased Medicaid and Title VII
funding), provision of volunteer services through programs, such as Donated Dental Services (DDS),
and bridging the divide between patients’ access and utilization through the use of community
services like transportation to indigent populations.
Specifically, the AGD’s proposed solutions to the access to and the utilization of oral health care
issues include, but are not limited to:
1. Extend the period over which student loans are forgiven to 10 years without tax liabilities for
the amount forgiven in any year;
2. Provide tax credits for establishing and operating a dental practice in an underserved area;2
1U.S.
Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: U.S.
Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research, 2000.
NIH publication 00-4713. Available from: URL: http://www.surgeongeneral.gov/library/oralhealth/
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2“The Maine Dental Association's own bill, called ‘An Act to Increase Access to Dental Care,’ has become law. Starting next year,
dentists will be eligible to receive up to $15,000 in income tax credit annually-for up to five years as long as they practice in
underserved areas. The law currently limits participation in the program to five dentists, but the legislature will review its
effectiveness in two years, and may then amend it to increase the number of allowed participants.” American Dental Association
(ADA) Update, June 10, 2008 (Retrievable from www.ada.org).
3. Provide federal loan guarantees and/or grants for the purchase of dental equipment and
materials;
4. Offer scholarships to dental students in exchange for committing to serve in an underserved
area;
5. Increase funding of and statutory support for expanded loan repayment programs (LRPs);
6. Increase appropriations for funding an increase in the number of dentists serving in the
National Health Service Corps and other federal programs, such as IHS, programs serving
other disadvantaged populations and U.S. Department of Health and Human Services (HHS)wide loan repayment authorities;
7. Actively recruit applicants for dental schools from underserved areas;
8. Assure funding for Title VII general practice residency (GPR) and pediatric dentistry
residencies;
9. Take steps to facilitate effective compliance with government-funded dental care programs
to achieve optimum oral health outcomes for indigent populations:
a. Raise Medicaid fees to at least the 75th percentile of dentists’ actual fees
b. Eliminate extraneous paperwork
c. Facilitate e-filing
d. Simplify Medicaid rules
e. Mandate prompt reimbursement
f. Educate Medicaid officials regarding the unique nature of dentistry
g. Provide block federal grants to states for innovative programs
h. Require mandatory annual dental examinations for children entering school
(analogous to immunizations) to determine their oral health status
i. Encourage culturally competent education of patients in proper oral hygiene and in
the importance of keeping scheduled appointments
j. Utilize case management to ensure that the patients are brought to the dental office
k. Increase general dentists’ understanding of the benefits of treating indigent
populations;
10. Establish alternative oral health care delivery service units:
a. Provide exams for one-year-old children as part of the recommendations for new
mothers to facilitate early screening
b. Provide oral health care, education, and preventive programs in schools
c. Arrange for transportation to and from care centers
d. Solicit volunteer participation from the private sector to staff the centers;
11. Encourage private organizations, such as Donated Dental Services (DDS), fraternal
organizations and religious groups to establish and provide service;
12. Provide mobile and portable dental units to service the underserved and indigent of all age
groups;
13. Identify educational resources for dentists on how to provide care to pediatric and special
needs patients and increase AGD dentist participation;
14. Provide information to dentists and their staffs on cultural diversity issues, which will help
them reduce or eliminate barriers to clear communication and enhance understanding of
treatment and treatment options;
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15. Pursue development of a comprehensive oral health education component for public
schools’ health curriculum in addition to providing editorial and consultative services to
primary and secondary school textbook publishers;
16. Increase supply of dental assistants and dental hygienists to engage in prevention efforts
within the dental team;
17. Expand the role of auxiliaries within the dental team, including a dentist or under the direct
supervision of a dentist;
18. Eliminate barriers and expand the role that retired dentists can play in providing service to
indigent populations;
19. Strengthen alliances with American Dental Education Association (ADEA) and other
professional organizations like the Association of State and Territorial Health Officials
(ASTHO), Association of State and Territorial Dental Directors (ASTDD), National Association
of Local Boards of Health (NALBOH), National Association of County & City Health Officials
(NACCHO) and so forth;
20. Lobby for and support efforts at building the public health infrastructure by using and
leveraging funds that are available for uses other than oral health; and
21. Increase funding for fluoride monitoring and surveillance programs, as well as for the
development and promotion of new fluoride infrastructure.
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Academy of General Dentistry (AGD)
White Paper on Increasing Access to and Utilization of Oral Health Care Services
I. Introduction
Patients who utilize the services of dentists in the United States enjoy the highest quality dental
care in the world. Dentistry is paid for primarily with private sector dollars. In 2004, for example,
state, local, and federal government programs paid less than $4.9 billion for dental care
compared with $81.5 billion paid through personal health care expenditures, such as out-ofpocket payments, third-party payments, or private health insurance.3
Among the health professions, dentistry is singularly oriented toward preventive health. The
National Institute of Dental and Craniofacial Research (NIDCR) estimates that dentistry’s
emphasis on preventive oral health measures saved nearly $39 billion during the 1980s. In
addition, the Centers for Disease Control and Prevention (CDC) said in an August 2000 letter to
Congress that community water fluoridation, which was introduced in public water supplies in
the 1940s to help prevent tooth decay, is “one of the greatest public health achievements of the
20th century.”
Despite dentistry’s successes, significant challenges lie ahead. Two of the biggest challenges in
achieving optimal health for all are: 1) underutilization of available oral health care; and 2)
maldistribution4 in areas of greatest need.
Access to care and utilization of care must be addressed from the perspective of patient needs,
especially the needs of underserved patients who are in greatest need of competent care and
exhibit complications and systemic health issues. The Academy of General Dentistry (AGD) is
very mindful of the Surgeon General’s report (Oral Health in America: A Report of the Surgeon
General) that stated that oral health care is intimately related to systemic health care. These
patients include the indigent, children, rural populations, the developmentally disabled,
elderly/nursing home patients, the medically compromised and transient/non-English speaking
populations.
Further, the profession must address other challenges, including non-economic barriers, to
access and utilization such as patients’ behavioral factors, levels of oral health literacy, special
needs, financial factors, two-tiered systems of delivery (poor quality care for the poor),
maldistribution of dentists and dental team auxiliaries, transportation, location and
cultural/linguistic preferences.
The profession is eager to work with private sector groups, community organizations, teaching
facilities, US Public Health Service Corps (Corps), Indian Health Service (IHS)
and state, local and federal lawmakers to increase oral health literacy to these populations,
reduce disparities in oral health status and increase access to and utilization
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3 The Centers for Medicare & Medicaid Services (CMS), Office of the Actuary, National Health Statistics Group (2004).
4 The term “maldistribution,” as used here and throughout this paper, does not imply or suggest an incorrect or wrongful
distribution, but rather, the term is synonymous with uneven distribution of dentists and dental teams in relation to the distribution
of the presently underserved.
of oral health care services, thereby reducing the incidence of dental disease and associated
systemic ailments.
II. Definitions
Access to Oral Health Care Services (Access to Care)—The ability of an individual to obtain
dental care, recognizing and addressing the unique barriers encountered by an individual
seeking dental care, including the patient's perceived need for care, oral health literacy, dentist
and dental team distribution, financial circumstances, special needs, transportation, location,
language, cultural preferences and other factors influencing entry into the dental care system.
Independent Mid-Level Provider5—A dental auxiliary, working outside the dental team and
without dentist supervision, who accepts the responsibility for patient diagnosis, treatment and
coordination of dental services with less education than what is currently required for a
practicing dentist.
Oral Health Literacy—The degree to which individuals have the capacity to obtain, process and
understand basic oral health information and services needed to make appropriate oral health
decisions.6
Underserved—Refers to patients including the poor/indigent, geographically isolated, medically
compromised, transient/non-English speaking, developmentally disabled, nursing-home bound
(and other institutionalized individuals), the elderly and children, who have historically
experienced lowered or no utilization of oral health care services but often exhibit greater need
for dental services. These individuals may also have concurrent co-morbidities that complicate
treatment, and inadequate oral interventions may lead to unintended adverse medical
outcomes.
Utilization of Oral Health Care Services (Utilization of Care)—The percentage of the population
receiving oral health care services through attendance to oral health care providers, while taking
into consideration factors including, but not limited to, health-related behaviors, oral health
literacy, dentist and dental team distribution, financial circumstances, special needs,
transportation, location, language, cultural preferences and other factors influencing entry into
the dental care system.
III. The State of Oral Health in the United States
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Dental disease is important because it impacts both children and adults physically, functionally,
emotionally, and socially. It also affects the nation’s productivity.
Currently there is no suitable definition for a “mid-level provider” within the dental team due to variations
and inconsistencies in both the usage of the term “mid-level provider” in dentistry and the delegation of
auxiliary duties by different states. The independent practice of dentistry by non-dentists, outside the
scope of the team concept, is a lower level of practice.
5
6Based
on the definition provided by the Healthy People 2010 report
Oral Health Is Key to General Health
Oral health has not been treated as the important part of overall health that it is. A person
cannot be healthy unless he or she also is healthy orally. The mouth can be the window to the
rest of the body; it often reflects general health and well-being; alternatively, it can indicate
disease and dysfunction. Oral infections can be the source of systemic disease. Individuals with
weakened immune systems are especially vulnerable to severe systemic complication,
sometimes life-threatening, from oral infections. In addition, research has found associations
between chronic oral infections and other health problems, including diabetes, heart disease,
and adverse pregnancy outcomes.
The need for dental care cannot be ignored. Unlike many medical conditions, dental problems
are not self-limiting. Dental diseases become progressively more severe without treatment,
requiring increasingly costly interventions. Initial disease attack, and the treatment required to
manage it, often lead to sequela, which require more radical and invasive interventions later in
life. On the other hand, most dental diseases are prevented easily at little cost through regular
examinations in conjunction with appropriate modern preventive modalities. In addition, the
initial recognition of life-threatening conditions like HIV infection and oral cancer are often
made in the dental office.
Parents must understand that oral health is much less arduous and less costly when care is
started early and maintained by the regular attendance of a dentist. All children need a dental
home and continuous comprehensive care.
IV. Challenges to Access to and Utilization of Care
Increasing utilization of care requires a significant and concentrated effort toward increasing
oral health literacy, especially among underserved populations. Increased oral health literacy
will allow individuals to see value and ask for services and will allow communities to develop a
culture of oral health as a priority that they should work to achieve. Further, increasing access
to care requires a multifaceted solution to promote the practice of quality dentistry in
underserved and rural areas and for those with intellectual and developmental disabilities, the
elderly, children, the medically compromised and transient/non-English speaking populations.
The dental profession is dedicated to working with governmental entities, community
organizations, and other private entities to develop solutions to these problems and work
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toward these endeavors. Workable solutions to access, utilization, and the maldistribution of
dentists and dental team auxiliaries are discussed further in Section V below.
The independent mid-level provider
One present challenge to access to and utilization of care arises from within the profession itself
and threatens not only to create a two-tiered system of delivery, providing poorer quality care
for poor and medically needy populations, but also to divert economic resources from oral
health literacy, expansion of quality care, correction of maldistribution, and, most importantly,
the commitment to prevention.
Numerous organizations have introduced concepts for advanced training of a hygienist, other
auxiliary or another non-dentist, to produce a less clinically and didactically trained provider,
commonly referred to as a “mid-level provider.” This individual will not have attained the
minimum education and competency levels of a dentist but would diagnose, treat and/or
manage the oral health of undeserved populations outside the support of a dental team and
independent of a dentist’s supervision.
Subtracting from the Prevention Model
Dentistry focuses on preventive care. Therefore, the AGD supports the dental team concept as
the best approach to providing the public with quality comprehensive dental care. Further, the
AGD recommends advanced training of auxiliaries to provide greater expertise of preventive
care and of treatment within the dental team concept or under the direct supervision of a
dentist. The dental team concept provides the patient with a dental home for continuity of
comprehensive care with a focus on prevention and treatment to forestall or mitigate the need
for cost-ineffective critical care. It also best ensures that the patient will receive appropriate,
competent and safe care.
Further, as stated above, the prevention model has produced not only health benefits to patient
populations, but also economic benefits to the health care system. Past advances in the
prevention and treatment of oral diseases have been estimated to generate savings of $5 billion
per year in dental expenditures alone. Dental expenditures in 2002 exceeded $70 billion, the
majority of which were associated with the repair of teeth and their surrounding tissues—and
which could have been prevented by regular professional dental care and good home care
instructions from the dentist and his/her staff. Auxiliaries play the key role in patient education
and preventive care within the dental team.
The concept of independent mid-level providers subtracts from the prevention model as part of
a comprehensive oral health umbrella of care to the detriment of access to and utilization of
care. Removing the oversight of the dentist removes the one professional who has the overall
knowledge and training to coordinate all aspects of treatment that patients might need.
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First, concepts that propose the use of the auxiliary workforce to fuel the development of
independent mid-level providers result only in the removal of auxiliaries from their preventive
role within the dental team. Presently, there is a clear maldistribution of hygienists within the
dental team, with some regions of the United States experiencing a shortage. The diversion of
resources to create an independent mid-level provider will serve to further the maldistribution
within the dental team and act as a disservice to disease prevention. The utilization of the
auxiliary workforce within the team is an approach that can still be enhanced to maximize the
benefit for the patients. Training and expanded functions within the dental team can easily
increase the number of patients a dentist can treat in a comprehensive manner. Diverting
auxiliaries into non-team areas has the opposite effect.
Second, prevention provided away from complete comprehensive care, including that of a
dentist, puts patients at risk of receiving inappropriate and possibly unsafe care. Patients
cannot be expected to make fine distinctions between alternative treatment choices. They
assume that the level of care that they receive is adequate and complete. A complete
comprehensive care setting will have preventive education for the patients and their family, plus
it will have the full compliment of care and diagnosis by a dentist. Without a comprehensive
care setting that includes the services of a dentist, duplication of services will become necessary.
Third, resources utilized to train independent practice hygienists or other independent mid-level
providers could otherwise be directed toward oral health literacy programs and recruitment
and incentives for dentists to practice in underserved areas.
1)
Those funds could be used to increase the numbers of dentists being trained, as well as
training for expanded duties assistants.
2)
The shortage of faculty and teaching facilities is already critical and this infrastructure
could not support the added requirement of teaching and time in training independent
mid-level providers.
3)
The development of a curriculum, which mirrors what is already being done but yields a
less qualified product, is a poor fiscal policy and wastes precious dollars and resources.
Conflicts with Economic Realities:
Independent mid-level providers will not be immune to the forces of supply and demand. They
will likely find it less economically feasible to maintain an independent practice in underserved
areas. The absence of a full-service, dentist-led practice will only compound their difficulties
because they will still have to bear the financial burden of maintaining fully equipped, modern
dental facilities and the resultant business risks of their investments. An ADA study7 revealed
that, when provided the opportunity to practice independently to serve the needy, the
overhead of maintaining a practice drives independent mid-level providers away from
underserved areas. Presuming that the pilot study serves as a microcosm, the mid-level concept
would fail to provide any indigent care, even care that falls short of the minimal standards of
quality and safety.
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Further, underserved areas may include remote rural areas or areas with high indigent
populations who are most in need of dental care but are the least able to pay for it. The dental
team concept, with the dentist in supervision of the practice, provides the hygienist with the
economic protection and freedom to expand his or her practice to serve the needs of lowincome populations through expanded services, such as the provision of hygiene education and
case management services (especially in the public health setting).
Further, the team concept provides the accessibility to the knowledge and resources needed to
address complications and compromised systemic health conditions that
often plague many of the underserved. Without the direct supervision of a dentist, the
independent mid-level provider will likely not find a dentist immediately accessible to address
complications. Given the finding that there is a maldistribution of dentists in
7 Brown, L.J., House, D.R., & Nash, K.D. The Economic Aspects of Private Unsupervised Hygiene Practice and Its Impact on Access to
Care. Dental Health Policy Analysis Series. American Dental Association, 2005.
underserved areas, the independent mid-level provider’s access to a dentist may meet the same
challenge as the patient’s direct access to and utilization of the services of a dentist.
That is, without dentist supervision through a dental team concept, the independent mid-level
provider, if economically able to practice in an underserved area at all, may only serve the
patients as an intermediary of time and money lost, not of care gained.
Fails Minimum Educational Standards:
Example independent mid-level provider concepts purport to include diagnostic, surgical, and
irreversible restorative services without the direct supervision of a dentist. The American Dental
Hygienists’ Association’s (ADHA) Draft Competencies referred to an excerpt of the American
Dental Education Association (ADEA) report, Unleashing the Potential, which reads, “In certain
settings and situations, they substitute for the dentist where there is none available.”8
Given that the unsupervised practice of an independent mid-level provider would mirror that of
a dentist in the services provided, inclusive of diagnoses and irreversible procedures that
presently are reserved for dentists, one must examine whether independent mid-level provider
education and training would meet the minimal competencies required of the dentist in the
performance of the same procedures.
The ADHA proposes an Advanced Dental Hygiene Practitioner (ADHP) master’s degree
curriculum to provide the hygienist with the competency required to provide diagnostic,
therapeutic, preventive, and restorative services. However, notwithstanding that currently
there is no Commission on Dental Accreditation (CODA) approved ADHP master’s degree
program, dental school curricula designed to graduate DDS recipients are structured to meet
only the minimum standards for competency in dentistry as set by the ADEA for CODA
accreditation. Competency achieved through graduate dental education toward a DDS or DMD
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degree sets the floor, and not the ceiling, for the practice of clinical dentistry. If these are the
minimum standards, anything less could not render a practitioner competent to perform
dentistry.
Therefore, an ADHP master’s degree curriculum, regardless of CODA accreditation, could not
meet the minimum standards of competence to provide dentistry—especially diagnostic and
irreversible dentistry—unless the ADHP master’s degree curriculum were to adopt the
prerequisites of dental school entry and meet or exceed the competencies achieved through
dental school. That is, the ADHP master’s degree candidate essentially would have to earn a
dentist’s degree to qualify as a practitioner of the aforementioned dental procedures.
Lesser Quality Care for Needier Patients:
Since the educational framework proposed by the ADHA—and other organizations touting
independent mid-level providers as solutions—is intended to fall short of comprehensive dental
school curricula, the quality of care that an independent mid-level provider provides would fall
short of the minimal competencies required of a dentist. One
8 Weaver, R.G., Valachovic, R.W., Hanlon, L.L., Mintz, J.S., and Chmar, J.E. Unleashing the Potential. American Dental Education
Association (ADEA). Retrieved June 27, 2008, from http://www.adea.org/cepr/Documents/Unleashing_the_Potential.pdf.
could argue that the benefit of competent care in dentistry already is a commodity only
available to those who can afford it and that those who cannot afford it presently get nothing.
However, the AGD strongly believes that those who cannot afford dental care, or perhaps are
not aware of the importance of oral health, nonetheless deserve the same quality and
competence of care as all.
Diagnosis and the performance of irreversible procedures by someone without a dentist’s
education compromise the safety of the patient. For the sake of patient safety, the AGD
therefore urges that auxiliaries must be prohibited from engaging in the performance of
irreversible procedures without direct dentist supervision9 and from diagnosing conditions of
oral health regardless of supervision.
Notwithstanding the inherent injustice in providing lesser quality and potentially unsafe care to
more needy patients, one must also consider that disadvantaged populations often have
neglected their dental health for years, thereby causing complications that are not as prevalent
in better-advantaged communities. Without the benefit of dentist supervision or a dental team
home, inappropriate care, possibly of unacceptable quality, may conceal or exacerbate
underlying medical concerns and undermine dentistry and health care’s growing effort to
address dentistry as a doorway for the prevention of numerous systemic ailments.
Dentistry Compared to Medicine:
One might contend that independent mid-level providers in medicine, such as advanced nurse
practitioners, have benefited the health care system. However, independent mid-level providers
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in dentistry and advanced nurse practitioners differ fundamentally in the models by which they
practice, or intend to practice.
The dental concept and medical concept are vastly different. With its focus on addressing
symptoms of illness rather than prevention of illness, the medical model is driven by a first
diagnosis at the patient’s “point of entry,” and often a second or third diagnosis based upon the
direction of referral. Therefore, in the medical model, the first diagnosis, regardless of by whom,
merely opens the gateway to further evaluation and need not disturb subsequent diagnosis or
the continuity of care.
On the other hand, dentistry has served its patients quite well through the prevention-based
“dental team concept” rather than a “point of entry” concept. The dental team concept serves
the function of dentistry and patients’ access to care with its focus not merely on diagnosis of
dental diseases, but rather on prevention and continuity of care through treatment. That is, in
dentistry, the “point of entry” is the point of prevention and treatment—it is not just a segue
to further diagnosis and possible intervention—thereby saving both time and cost.
9 If delivery of a local anesthetic is defined as an irreversible procedure, then said delivery may be considered an exception to the
prohibition against practice without direct supervision if within the bounds of the laws and regulations of the respective jurisdiction.
Additionally, jurisdictions may offer differing viewpoints on the scope of irreversible procedures and the allowance for non-dentists
to perform them; however, whether these procedures, such as placement of a core, may be performed without the direct
supervision of a dentist would require review and scrutiny on a case-by-case basis to ensure patient safety.
Further, treatment by a dental team varies within acceptable standards of care based upon the
assessments, competencies, and preferred methodologies of the core dentist. Therefore,
fragmentation of diagnosis or preliminary treatment shall not only hinder the dental team
concept and dentistry’s comprehensive view of treatment, but also it will hinder access to
consistent quality care. That is, care shall be rendered discontinuous.
Finally, it should be noted that dentistry faces significantly lesser insurance coverage for patients
than medicine does. Nonetheless, insurance companies are likely to push patients to lower
cost care to the detriment of the patient. The AGD resists that effort and encourages
competitive quality care to remain within the delivery of oral health care, inclusive of portability
of any and all existing insurance coverage.
Therefore, while one can appreciate the medical model’s efforts at an albeit inadequate solution
to access to care with the adaptation of the nurse practitioner/physician assistant, a similar
model likely would produce the opposite of the intended effect in dentistry; that is, it would
disrupt continuity of care and access to quality of care for patient populations.
The Meaning of Quality Care:
Defining the challenge in providing access to quality care is the first step in addressing the
challenge. Access to quality care has two components: access and quality. Quality is a necessary
component of access to care in order to ensure patient safety.
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Accessibility without quality echoes the “something is better than nothing” approach to care.
However, this approach serves only injustice, and not the public need. A court of law does not
provide an indigent defendant with a paralegal if he or she cannot afford an attorney. In
dentistry, this approach is naïve and can lead to tragedy. Inappropriate care, which may lead to
unnecessary and dangerous complications, is not better than nothing—in fact, it can be
enormously worse. Consequently, accessibility in dentistry is meaningless without the
assurance of quality care.
Therefore, the inadequately supervised independent mid-level provider holds the false goal of
access to and utilization of care by compromising quality and safety while diverting valuable
resources away from oral health literacy and expansion of quality care into underserved areas.
V. Increasing Access and Utilization—A Comprehensive Patient-centered Solution
The profession of dentistry recognizes that the state of oral health cannot be materially
advanced without addressing both access to and utilization of care. There are many different
factors contributing to disparities in, lack of access to, and low utilization of oral health care
services. Given the complexity of the issue, any solution will require a multi-faceted approach
that strengthens the parts of the dental delivery system that are working and creates new
opportunities to improve the oral health of the nation.
Oral Health Literacy
Oral health literacy must be a cornerstone of improving utilization of care by underserved
populations. Professional organizations such as the AGD actively promote publicly available
culturally relevant literature and other means to increase oral health literacy among
underserved populations. However, true advances in oral health literacy must be driven by
collaboration between professional organizations, community organizations, other private
entities and governmental entities.10
The AGD believes health policymakers at the local, state and federal levels should continue their
efforts to collaborate with the private sector to develop strategies for increasing access to and
use of dental services and for decreasing oral health disparities and low oral health literacy. The
groundbreaking release, Oral Health in America: A Report of the Surgeon General, in May 2000
recommended such public-private partnerships. Further, in the report, then-Surgeon General
David Satcher, MD, PhD, referred to a “silent epidemic” of oral diseases among certain
population groups in the United States. Following are just a few examples of activities that the
AGD has undertaken in an effort to address the Surgeon General’s Call to Action and to achieve
HHS’ Healthy People 2010 oral health objectives:
1)The AGD created policy resolutions that if implemented would encourage adoption of policies
that oppose soda pouring rights in schools because of the deleterious effect on oral health
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resulting from easy access and increased consumption of soda and increase education on
the importance of good nutrition and how good nutrition relates to good oral health.
2)The AGD’s Public Relations Council regularly promotes topics and press releases on issues of
interest to help mass media increase the consumer’s awareness of oral health issues. For
example:
a) The council developed a Dentalnotes story, “Dental Sealants—Is Your Child a
Candidate?” which included information obtained from the CDC and referenced the
Healthy People 2010 objectives related to sealants;
b) Built relationships with HHS, Office of Public Health and Science/Office of the Surgeon
General allowing for the council’s input on a national public service
announcement, which reached the top 10 media markets with a message about the link
between dental health and overall health;
c) The council hosted an oral cancer screening event on July 17, 2003. More than 50
consumers were screened, 10 patients were encouraged to visit a dentist, and media
coverage included The Tennessean, Nashville City Paper, WTVF-TV, WLAC-AM; and
d) The council hosts SmileLine events at AGD’s annual meetings in order to answer patient
inquiries about oral health. In 2003, more than 648 calls were answered,
10 As a related component of oral health literacy, the AGD believes in the acceptance and execution of personal responsibility by
patients. Being literate about one’s oral health, especially in the context of receiving government provided benefits means, for
instance, ensuring that one and one’s children show up for scheduled appointments. The AGD also believes that a pecuniary interest
in treatment facilitates personal responsibility. Commentators ranging from Adam Smith to Milton Friedman have clearly
demonstrated that when a financial incentive exists, one is more likely to ensure optimal outcomes. In the context of both private
insurance and government benefits, therefore, such a financial incentive would take the form of co-payment for treatment. This
construct is even more important for lower socio-economic classes, which might not regularly be exposed to the profit motive.
d) 50 questions were posted to SmileLine Online during the week of event, and 100
volunteers fielded a minimum of approximately eight calls per line per hour.
3)The AGD has worked with the American Optometric Association (AOA) and the American
Diabetes Association to inform patients about “above-the-neck” warning signs for diabetes,
such as bad breath, bleeding gums, and blurred vision.
4)The AGD’s Legislative and Governmental Affairs (LGA) Council focuses its attention on
promotion and implementation of the AGD’s Memorandum of Understanding (MOU) with
HHS. The purpose of the MOU is to provide a framework for cooperation between HHS and
the AGD for promoting the Healthy People 2010 oral health objectives with a focus on
access to care, training of workforce, and the education of the public, the profession of
general dentistry, and policymakers. This MOU, unique in organized dentistry, is directed to
access to care through education of the public and policymakers about the links between
oral health and overall health.
Incentives for Dentists to Practice in Underserved Areas
The AGD recognizes that the maldistribution of dentists is a significant challenge to access to
care. To successfully produce equitable distribution in areas now deemed underserved,
incentives must be established to encourage dentists, especially those with GPR or AED
training, who have attained the education and expertise to competently and comprehensively
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address the oral health needs of potentially compromised populations and to practice in
underserved areas in conjunction with their dental teams.
The AGD proposes the following steps—which are not to be construed as all-inclusive—as
incentives to practice in underserved areas and to increase access to care:
1. Extend the period during which student loans are forgiven to 10 years, without tax
liabilities for the amount forgiven in any year;
2. Provide tax credits for establishing and operating a dental practice in an
underserved area;11
3. Offer scholarships to dental students in exchange for committing to serve in an
underserved area;
4. Increase funding of and statutory support for expanded loan repayment programs
(LRPs);
5. Provide federal loan guarantees and/or grants for the purchase of dental equipment
and materials;
6. Increase appropriations for funding an increase in the number of dentists serving in
the National Health Service Corps and other federal programs, such
11 “The Maine Dental Association’s own bill, called ‘An Act to Increase Access to Dental Care,’ has become law. Starting next
year, dentists will be eligible to receive up to $15,000 in income tax credit annually-for up to five years as long as they practice in
underserved areas. The law currently limits participation in the program to five dentists, but the legislature will review its
effectiveness in two years, and may then amend it to increase the number of allowed participants.” American Dental Association
(ADA) Update, June 10, 2008. (Retrievable from www.ada.org.)
as Indian Health Service (IHS) and programs serving other disadvantaged
populations, and HHS-wide loan repayment authorities;
7. Actively recruit applicants for dental schools from underserved areas; and
8. Assure funding for Title VII GPR and Pediatric Dentistry Residencies.
Specifically, the GPR and pediatric dentistry residency programs funded by the appropriations
bill for the HHS, and education as part of the Health Professions Program under Title VII of the
Public Health Service Act, are proven cost-effective, primary care residency programs. They are
a small investment with clear benefits.
During the 20-year history of the Title VII support for general dentistry training, 59 new dental
residency programs and 560 new positions were created. Approximately 305 of the dentistry
graduates from these programs established practices and spent 50 percent or more of their time
in health professional shortage areas or settings providing care to underserved communities.
The benefits of GPR programs include:
More primary care providers: GPR programs provide dental graduates with broad skills and
clinical experience, allowing them to rely less on specialists. Residents are trained to provide
dental care to patients requiring specialized or complex care, such as individuals with
intellectual and developmental disabilities, the elderly, high-risk medical patients and patients
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with HIV/AIDS. Eighty-seven percent of the graduates of GPR programs remain primary care
providers after graduation.
Better distribution of care: General practice residency programs improve distribution into
underserved areas. A 2001 Health Resources and Services Administration (HRSA) funded study
found that postdoctoral general dentistry training programs, which typically either are dental
school- or hospital-based, generally serve as safety net providers to underserved populations.
The GPR program is a model for the type of program that the government should support during
times of scarce resources because it is cost-effective, it targets and provides care to underserved
populations and it trains practitioners to become comprehensive general dentists, thus keeping
more future health care costs to a minimum due to its primary care emphasis.
Legislative and Community Initiatives for Increasing Access to and Utilization of Care
It should be noted that the majority of the areas that the federal government considers
underserved are determined by the low economics of the region. This also should bring an
understanding that the care in the areas where these patients in the underserved areas live is
funded substantially by government-funded programs (i.e., Medicaid).
Historically, when states have raised the Medicaid reimbursement rates, the number of
provider dentists have increased, which, in turn, has led to a direct increase in patients in
underserved areas receiving care.12
Specifically, the following are some of the steps that the AGD recommends to increase both
access to care and utilization of care:
1)Take steps to facilitate effective compliance with government-funded dental care programs to
achieve optimum oral health outcomes for indigent populations:
a) Raise Medicaid fees to at least the 75th percentile of dentists’ actual fees;
b) Eliminate extraneous paperwork;
c) Facilitate e-filing;
d) Simplify Medicaid rules;
e) Mandate prompt reimbursement;
f) Educate Medicaid officials regarding the unique nature of dentistry;
g) Provide block federal grants to states for innovative programs;
h) Require mandatory annual dental examinations for children entering school (analogous
to immunizations) to determine their oral health status;
i) Encourage culturally competent education of patients in proper oral hygiene and the
importance of keeping scheduled appointments;
j) Utilize case management to ensure that the patients are brought to the dental office;
and
k) Increase general dentists’ understanding of the benefits of treating the indigent.
2)Establish alternative oral health care delivery service units:
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a) Provide exams for one-year-old children as part of the recommendations for new
mothers to facilitate early screening;
b) Provide oral health care, education, and preventive programs in schools;
c) Arrange for transportation to and from care centers; and
d) Solicit volunteer participation from the private sector to staff the centers.
3)Encourage private organizations, such as Donated Dental Services (DDS), fraternal
organizations, and religious groups to establish and provide service;
4)Provide mobile and portable dental units to service the underserved and indigent of all age
groups;
5)Identify educational resources for dentists on how to provide care to pediatric and special
needs patients and increase AGD dentist participation;
Provide information to dentists and their staffs on cultural diversity issues that will help
them reduce or eliminate barriers to clear communication and enhance understanding of
treatment and treatment options;
6)Pursue development of a comprehensive oral health education component for public schools’
health curriculum in addition to providing editorial and consultative services to primary and
secondary school textbook publishers;
12 “Over the past decade, Medicaid and Head Start programs have sought to enhance the enrollees’ access to early, ongoing,
appropriate, comprehensive dental services. However, progress…[has been] hindered by long-standing barriers that discourage
dentists’ participation in Medicaid. Included among the most widely identified barriers are inadequate program financing and
reimbursement.” National Oral Health Policy Center, Technical Issue Brief, October, 2007. When Medicaid has been expanded and
reimbursement rates raised, utilization and care have increased. For example, “in 2000, Michigan’s Medicaid dental program
initiated Healthy Kids Dental, or HKD, a demonstration program offering dental coverage to Medicaid-enrolled children in selected
counties. The program was administered through a private dental carrier at private reimbursement levels… Under HKD, dental care
utilization increased 31.4 percent overall and 39 percent among children continuously enrolled for 12 months, compared with the
previous year under Medicaid. Dentists’ participation increased substantially, and the distance traveled by patients for appointments
was cut in half.” Michigan Medicaid’s Healthy Kids Dental Program: An Assessment of the First 12 Months (2003). Journal of the
American Dental Association (JADA), Vol. 134, 1509-15 (November, 2003). Michigan is one of many other states where similar results
have been noted.
7)Increase supply of dental assistants and dental hygienists to engage in prevention efforts
within the dental team;
8)Expand the role of auxiliaries within the dental team including a dentist or under the direct
supervision of a dentist;
9)Eliminate barriers and expand the role that retired dentists can play in providing service to
indigent populations;
10) Strengthen alliances with ADEA and other professional organizations, such as the
Association of State and Territorial Health Officials (ASTHO), Association of State and
Territorial Dental Directors (ASTDD), National Association of Local Boards of Health
(NALBOH), National Association of County & City Health Officials (NACCHO) and so forth;
11) Lobby for and support efforts at building the public health infrastructure by using and
leveraging funds that are available for uses other than oral health; and
12) Increase funding for fluoride monitoring and surveillance programs as well as for the
development and promotion of new fluoride infrastructure.
An important distinction must be made between supporting the advancement of auxiliaries
within the dental team or under dentist supervision and opposing the independent practice of
independent mid-level providers. Education has been the hallmark of the AGD since its
inception. The education of auxiliaries within the dental team concept will advance the
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interests of patient health. On the other hand, as explained above, the practice of independent
mid-level providers impedes the access to and utilization of oral health care services.
Rather, the AGD strongly supports those individuals who reside in federally designated
underserved areas, especially if they possess cultural competency, and who are interested in
performing irreversible oral health procedures, to matriculate in dental school. The AGD
stands ready to lobby both Congress and state legislatures to ensure that there are appropriate
funding mechanisms for such educational endeavors. The AGD further warrants that, based on
its long history of supporting continuing education and its support of mentoring programs, it will
make every effort for established dentists to take all necessary steps to ensure the professional
development of these new dentists.
VI. Conclusion
The AGD believes the role of the general dentist, in conjunction with the dental team, is of
paramount importance in improving both access to and utilization of oral health care services.
The AGD is willing and capable of working with other communities of interest to address and
solve disparities in access to and utilization of care across the nation. We should work together
to make sure that all Americans receive the very best comprehensive dental care that will give
them optimal dental health and overall health.
During this process, we must maintain our focus on the patient and maintain awareness that
dentistry works best as a preventive system. As noted in Oral Health in America: A Report of the
Surgeon General, “Oral diseases are progressive and cumulative and become more complex
over time.” Fortunately, “Most common oral diseases can be prevented.”
ACKNOWLEDGEMENTS
The Academy of General Dentistry (AGD) White Paper on Increasing Access to and Utilization of Oral
Health Care Services (White Paper) was developed by the Board Task Force on Access to Care in
collaboration with task force consultants, Dental Care (DC) and Legislative & Governmental Affairs (LGA)
Councils, the Division Coordinator to the DC and LGA Councils, the Executive Committee, AGD Staff, and
the Special Consultant to the Task Force. The White Paper could not have been completed successfully
without the dedication, persistence, expertise, and tireless efforts of these individuals, and therefore,
they are recognized by name as follows:
Task Force on Access to Care
LGA Council 2007-08
John T. Sherwin, DDS, FAGD (Chair)
Board Liaison, LGA Council
Orange, VA
Daniel K. Cheek, DDS
Private Practice, Hillsborough, NC
Michael J. Goulding, DDS, FAGD
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Myron J. Bromberg, DDS
Chair, LGA Council
Reseda, CA
W. Carter Brown, DMD, FAGD
Board Liaison, Group Benefits Council
Greenville, SC
Howard R. Gamble, DMD, FAGD
AGD Speaker of the House
Sheffield, AL
Joseph F. Hagenbruch, DMD, FAGD
(Former) Advocacy Division Coordinator
Harvard, IL
Mark S. Ritz, DDS, MAGD
(Former) Chair, Dental Practice Council
Homerville, GA
Private Practice, Fort Worth, TX
Leslie E. Grant, DDS
Dental Compliance Officer,
State Board of Dental Examiners
Glen Arm, MD
Daniel F. Martel, DDS, MAGD
Private Practice, Fredericksburg, PA
Dennis P. Morehart, DDS, MAGD
Private Practice, Enid, OK
M. Samantha Shaver, DMD, FAGD
Private Practice, Louisville, KY
John P. Storz, DMD, MAGD, ABGD
Army Dental Corps, Washington, DC
Michael D. Tillman, DDS, MAGD
Private Practice, Fort Worth, TX
Task Force Consultants
Division Coordinator
Richard W. Dycus, DDS, FAGD
(Former) Chair, LGA Council
Cookeville, TN
Mark I. Malterud, DDS, MAGD
President/Editor, Minnesota AGD
Saint Paul, MN
Lee Shackelford, DDS, FAGD
AGD Dental Practice Council
Clarksburg, MD
Susan Bordenave-Bishop, DMD, MAGD
Advocacy Division Coordinator
Peoria, IL
Special Consultant to the Task Force
L. Jackson Brown, DDS, PhD
(Former) Associate Executive Director
ADA Health Policy Resources Center
DC Council 2007-08
Joseph A. Battaglia, DMD, FAGD
Chair, Dental Practice Council
Wayne, NJ
Lawrence Bailey, DDS, FAGD
Public Health Practice, New York, NY
Executive Committee 2007-08
Vincent C. Mayher, Jr., DMD, MAGD
President, Haddonfield, NJ
Paula S. Jones, DDS, FAGD
President-Elect, Naperville, IL
David F. Halpern, DMD, FAGD
Vice-President, Columbia, MD
Bruce R. DeGinder, DDS, MAGD
Immediate Past-President
Williamsburg, VA
Jeffrey M. Cole, DDS, FAGD
Treasurer, Wilmington, DE
Linda J. Edgar, DDS, MAGD
Secretary, Federal Way, WA
Roger D. Winland, DDS, MS, MAGD
Editor, Athens, OH
Staff
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Richard D. Crowder, DDS
Private Practice, Lenexa, KS
John W. Drumm, DMD
Private Practice, Washington, DC
Edgardo F. Enriquez, DDS, FAGD
Private Practice, Fairfield, PA
Ronald D. Giordan, DDS, MAGD
Private Practice, Goodyear, AZ
Gary E. Heyamoto, DDS, MAGD
Private Practice, Bothell, WA
Christie Tarantino, CAE
Executive Director
Daniel J. Buksa, J.D.
Associate Executive Director,
Public Affairs
Srinivasan Varadarajan, Esq.
Director, Dental Care Advocacy
Michelle Fratamico
Manager, Advocacy
Academy of General Dentistry, July 2008
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